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Medical Forum / Diseases and Disorders / Diabetes / March 2006Bill (S.1955) Will Leave Many Diabetics without Diabetes Coverage!!
In a FEW SHORT WEEKS Bill called Health Insurance Marketplace Modernization and Affordability Act (HIMMA, S. 1955) will come up for vote in the Senate and if it passes it will be HORRIBLE for the Diabetes Community. It overrides state laws that insist upon diabetes coverage in plans and allows business owners and insurance companies to decide what will be covered in specific health plans. Millions with Diabetes will not be covered and have to pay OUT OF POCKET FOR CARE. FROM AMERICAN DIABETES ASSOCIATION: Enzi Health Insurance Legislation Would Jeopardize Lifesaving Coverage Protections for Millions with Diabetes Bill, S.1955, would allow health insurers to circumvent existing laws in 46 states that guarantee coverage for diabetes medications, supplies and training Alexandria, VA (March 7, 2006) The American Diabetes Association (ADA) today expressed its strong opposition to proposed federal legislation that would enable health insurers to bypass existing state health insurance regulations. In doing so, the "Health Insurance Marketplace Modernization and Affordability Act" (S. 1955) would result in the loss of critical health coverage guarantees for millions of people with diabetes. Forty-six states and the District of Columbia require insurers to provide coverage for diabetes supplies, medication, equipment and education, but S. 1955 would undermine those basic protections. The Senate Health, Education, Labor and Pensions (HELP) Committee, chaired by bill sponsor Senator Michael Enzi, will mark up the bill Wednesday morning. At the markup, Senator Jeff Bingaman will offer an amendment to protect the diabetes coverage benefit in the states where it is maintained in state law. "These protections were enacted over the past decade with the bipartisan support of legislatures, governors, and state insurance commissioners," L. Hunter Limbaugh, the ADA's Chair for Advocacy, today wrote Sen. Enzi. "It has been the Association's experience that without these protections, state-regulated insurers often do not provide adequate diabetes coverage. Indeed, in the four current states without mandated diabetes coverage, insurers often do not provide these life-saving diabetes provisions." The American Diabetes Association is committed to ensuring that the 20.8 million Americans with diabetes have access to the health coverage they need to manage the disease and prevent its serious and costly complications, including heart disease and stroke, kidney disease, blindness and amputations. A critically important component of this effort has been the consumer protections in 46 states requiring insurers to provide adequate coverage for diabetes supplies, equipment and education. Those protections have been vital to millions of people with diabetes. In attempting to provide much-needed relief to small business owners, S.1955 would make changes that would impact all state-regulated plans, and would result in millions of Americans with diabetes losing their guarantee of diabetes coverage. "Passage of this legislation would not come at a worse time," Limbaugh said. "At a time when the diabetes epidemic is worsening and the associated costs of complications are rising, it is unwise to allow insurers to reduce or eliminate coverage for diabetes tools. An increase in diabetes prevalence coupled with poor diabetes management, ultimately will increase the burden on the nation's already strapped healthcare system." The ADA is encouraging the HELP Committee to support Senator Bingaman's diabetes protection amendment, which would not create any additional mandated coverage, but would ensure that the legislation includes cost-effective diabetes coverage in states where such laws already exist. The cost of diabetes mandates on health insurance premiums has been studied by numerous states and has proven to have an insignificant effect on the overall cost of monthly health insurance premiums. Louisiana, for example, found that their diabetes requirement accounted for a mere .006% of monthly premiums. After conducting a comprehensive analysis of Utah's diabetes mandate, state legislators chose to strengthen their state law, doing away with a sunset clause that would abolish the diabetes requirement if they found the cost too burdensome. "At a time when diabetes has become an epidemic in this country, we should be doing more, not less, when it comes to diabetes health coverage," Limbaugh added. "States have taken the initiative to provide vital diabetes coverage for people in their state. Unfortunately, this legislation would strike a blow to those efforts. While the American Diabetes Association shares the concern for helping small businesses provide health insurance to their employees, we strongly believe that this legislation is not the answer." I could not agree more this legislation has to be stopped. It is taking helathcare in exactly the wrong direction. This legislation has some good ideas in it like alllowing small businesses to pool together but the trade off is horrible. This legislation removes state mandates that are essentail consumer protections and would allow helathcare policis to exclude coverage for diabtetes and a host of other common ilnesses. Contact your Senator please http://www.senate.gov/general/contact_information/senators_cfm.cfm > In a FEW SHORT WEEKS Bill called Health Insurance Marketplace > Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 78 lines] > provide health insurance to their employees, we strongly believe that > this legislation is not the answer." Please cite the section you feel will hurt us DM's. I've got the Bill in front of me, but don't want to read every page of it to get to the part that will effect us. Dave Dave, The bill would make state law that make it illegal for insurance companies not to cover for the expensive medicines and other procedures that diabetics need Null and Void. Therefore, it will no long be mandatory that insurance coveres diabetes care. Clearly it doesn't come right out and say that in the bill, but that is what can happen once the states no longer have the power to demand certain coverage is offered by all plans. <snip> > Please cite the section you feel will hurt us DM's. I've got the Bill in > front of me, but don't want to read every page of it to get to the part > that will effect us. > > Dave Here is an article from the American Diabetes Association that discusses this bill and asks people to contact their senators: http://us.f604.mail.yahoo.com/ym/ShowLetter?MsgId=4792_3526870_564741_1489_26400 _0_18157_73058_471976491&Idx=7&YY=75057&inc=200&order=down&sort=date&pos=0&view= a&head=b&box=Inbox#1 ...And here is a shorter follow-up article from ADA that briefly describes the problem and suggests that people contact their senators during the recess: https://secure2.convio.net/adap/site/Advocacy?pagename=homepage&page=SplashPage& id=792&JServSessionIdr011=fll69wvwd1.app27b I apologize for the long URLs. I usually use tinyURL for this type of link, but I received "page not available" from that source this afternoon. MaryL > In a FEW SHORT WEEKS Bill called Health Insurance Marketplace > Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 3 lines] > decide what will be covered in specific health plans. Millions with > Diabetes will not be covered and have to pay OUT OF POCKET FOR CARE. And people in the US have the balls to poke fun at the NHS in the UK.  SignatureBeav OMF#19 VN 750 Zed Thou mail is beavis dot original at ntlworld dot com (with the obvious changes) > And people in the US have the balls to poke fun at the NHS in the UK. I haven't seen anyone in the US poking fun at the NHS. Most of us envy you living somewhere that health coverage, whatever the quality, is available to everyone and where a single visit to an emergency room doesn't have the potential to doom you to going without insurance for the rest of your life. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >>In a FEW SHORT WEEKS Bill called Health Insurance Marketplace >>Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 5 lines] > > And people in the US have the balls to poke fun at the NHS in the UK. Well I only worry about the hoops I have to deal with at home. We all have a boatload of government and commercial wankerness to deal with. Any comparisons are like: My dog is bigger than yours. Hey the days are getting longer and maybe we both might get to see the sun once a week! How's the rice burning Kow running? > In a FEW SHORT WEEKS Bill called Health Insurance Marketplace > Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 3 lines] > decide what will be covered in specific health plans. Millions with > Diabetes will not be covered and have to pay OUT OF POCKET FOR CARE. Personally, I hope it passes. Because my state requires that insurance cover diabetes, I can not buy health coverage at any price. If I can exclude diabetes from my coverage, I'll be able to buy health insurance. Millions with diabetes will finally be able to get insurance. : > In a FEW SHORT WEEKS Bill called Health Insurance Marketplace : > Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 11 lines] : : Millions with diabetes will finally be able to get insurance. You're wrong. I live in one of the last 4 states that do not fall under being making insurance co's cover diabetics. I cannot get private health care for myself. I'm fighting to have my state added to make them required to cover my supplies and treatment. You own no one an apology. Believe me, this makes me madder than hell. Don't forget though, you and other's affected by diabetes can use the power of voice to possibly stop this legislation's enactment. Again, there is this option: https://secure2.convio.net/adap/site/Advocacy?pagename=homepage&page=SplashPage& id=792&JServSessionIdr011=fll69wvwd1.app27b And you can call the offices of your Senators and voice your opposition to this! > In a FEW SHORT WEEKS Bill called Health Insurance Marketplace > Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 3 lines] > decide what will be covered in specific health plans. Millions with > Diabetes will not be covered and have to pay OUT OF POCKET FOR CARE. The extraordinary costs of health care has forced this outcome. Diabetics happens to be one of the expensive diseases. It's easy to think that every cost...or at least every drug or procedure...must be covered by insurance...because that's the way it was done before. So it's kind of a rude awakening when someone says "enough is enough!" >From where I sit, as a person who uses natural methods to take care of my health, I'm an observer of the frantic 'crisis' that people feel because they don't appreciate the options that are out there that are so much less costly...by a factor of 100 or 1,000 sometimes...and just as effective and more so. It concerns me a great deal how the trillions spent on sickness care are hurting this nation both economically and in terms of how many people are physically maimed/amputated/etc by the expensive process. We must stop following this blind road that is leading to a future catastrophe for the US. In 20 years, if we were to continue on the path we're now taking, there will be too many seriously sick people and too few healthy ones. The bill you're compaining about is merely a reflection of how things starting to burst at the seams. > FROM AMERICAN DIABETES ASSOCIATION: > [quoted text clipped - 70 lines] > provide health insurance to their employees, we strongly believe that > this legislation is not the answer." >> In a FEW SHORT WEEKS Bill called Health Insurance Marketplace >> Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 6 lines] > The extraordinary costs of health care has forced this outcome. > Diabetics happens to be one of the expensive diseases. Yes, diabetes can be an expensive disease, but not nearly as expensive as many diseases/health issues that *are* covered. Moreover, we're talking about insurance here. If insurance companies can simply exclude every problem that is "inconvenient" for them, what's to prevent them from excluding cancer, heart disease, etc.? > It's easy to think that every cost...or at least every drug or > procedure...must be covered by insurance...because that's the way it [quoted text clipped - 12 lines] > must stop following this blind road that is leading to a future > catastrophe for the US. And what do you think should happen to the person who needs an amputation? Just let the person die because it is expensive?? > In 20 years, if we were to continue on the path we're now taking, there > will be too many seriously sick people and too few healthy ones. The > bill you're compaining about is merely a reflection of how things > starting to burst at the seams. > >> In a FEW SHORT WEEKS Bill called Health Insurance Marketplace > >> Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 12 lines] > problem that is "inconvenient" for them, what's to prevent them from > excluding cancer, heart disease, etc.? I agree with every point you make. The probem is that insurance is a business like any other business in that it is set up to make a profit. They realize from their records and from the way diabetes is trending with type II doubling in children over the last 10 years or so, that it becomes impossible to keep covering every new drug and procedure that comes down the pike and still make a profit. By the way diabetics have an increased incidence of both cancer and heart disease. So that disease is a driver for higher insurance costs in more ways than one. > > It's easy to think that every cost...or at least every drug or > > procedure...must be covered by insurance...because that's the way it [quoted text clipped - 15 lines] > And what do you think should happen to the person who needs an amputation? > Just let the person die because it is expensive?? I've read about cases of diabetics and met people who were supposedly in need of an amputation, but who were able to reverse their condition, either through chelation or some other natural treatment. As I mentioned before, the costs of these types of alternative treatments are far less than the types of procedures that you want covered. The reality is that insurers can't continue to afford covering those expensive procedures because too many people have diabetes. As they used to say, "You can't get there from here." > > In 20 years, if we were to continue on the path we're now taking, there > > will be too many seriously sick people and too few healthy ones. The > > bill you're compaining about is merely a reflection of how things > > starting to burst at the seams. >> >> In a FEW SHORT WEEKS Bill called Health Insurance Marketplace >> >> Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 62 lines] >> > bill you're compaining about is merely a reflection of how things >> > starting to burst at the seams. Just to be a bit facietious here (but with a certain element of truth)...What would your attitude be if you had paid for homeowners' fire insurance for a number of years, then had a fire and were told, "Sorry, your insurance doesn't cover the bedrooms"? That's not *too* far removed from selectively covering (or not covering) specific diseases, especially when we are not discussing experimental drugs. As to your comments about amputation, it may be true that some people have been able to reverse their condition. I think it is also true that many people would have died without the operation. MaryL >> Yes, diabetes can be an expensive disease, but not nearly as expensive as >> many diseases/health issues that *are* covered. Moreover, we're talking [quoted text clipped - 10 lines] >covering every new drug and procedure that comes down the pike and >still make a profit. Remember that for the most part, new drugs and procedures replace old ones. Sometimes a new drug is even cheaper than an old procedure. Health insurance companies don't have the same problems as life insurance companies: they aren't locked into a long-term contract and they can raise premiums each year if their costs go up. Insurance doesn't like to cover the *cheap* stuff since nobody will bother to buy insurance to cover the *cheap* stuff, and claim handling costs too much compared to the premium costs. When was the last time you heard someone advertising Toilet Paper Insurance? (You buy it and when you have to go, you file a claim. Obviously, diarrhea won't be covered :-) ). Or for that matter, Food Insurance? Insurance best covers risks that the average person cannot handle himself (fire insurance, flood insurance, life insurance, catastrophic health insurance). The most obvious things to cover with insurance are the catastrophic expensive diseases like cancer, heart disease, and diabetes. The most obvious things to NOT cover (or cover less) with insurance are the routine things like annual checkups, flu medication, and minor cuts and scrapes. Insurance companies can do plenty of things to improve their profit without trying to pick and choose diseases: - Increase premiums - Increase deductibles (e.g. $40 per doctor visit instead of $20, $1000 annual deductible instead of $250, 80% of hospital stays instead of 90%). - Lower caps on benefits. There are caps on lifetime benefits now. I don't know how many people actually hit them. Two heart attacks and you might find that your insurance won't pay for a scraped knee. Incidentally, I think health insurance companies could still sell their insurance WITHOUT PAYING BENEFITS. How? They act as volume buyers for health services at discount prices. Suppose I had a Blue Cross-Blue Shield policy with a $1 trillion deductible. They'll never pay a cent. But my bill for lab services might still say $400 billed, $75 allowed, PATIENT DOES NOT PAY THE BALANCE. (Those values approximate a real bill for lab tests that actually happened, and I'm not exaggerating the difference between the billed funny-money and the actual payment). The ones that get stuck with the ridiculous funny-money price are the poor who "can't afford" insurance and the uninsurable. The insurance company nightmare is the cheap pill that cures everything for $10. Nobody would bother buying health insurance. Gordon L. Burditt > The probem is that insurance is a business like any other business in > that it is set up to make a profit. No. Insurance is a highly regulated industry which offers coverage required by government at prices allowed by government. Think of the profits that could be made if they could provide what the consumer wants! > > The probem is that insurance is a business like any other business in > > that it is set up to make a profit. [quoted text clipped - 6 lines] > Think of the profits that could be made if they could provide > what the consumer wants! You missed what I said...I said that the insurance industry is like any other business IN THAT it is set up to make a profit. The insurance industry is not a non-profit industry. Their rates reflect what it takes for them to make a profit. If a gov't regulation makes it unlikely that they can make a profit, you'll see the insurance company not offering the product before too long. > Yes, diabetes can be an expensive disease, but not nearly as expensive as > many diseases/health issues that *are* covered. Moreover, we're talking > about insurance here. If insurance companies can simply exclude every > problem that is "inconvenient" for them, what's to prevent them from > excluding cancer, heart disease, etc.? Insurance companies should be allowed to offer different products to the consumer, with the price reflecting the coverage. Would you like it if the state required all cars to have navigation systems, metalflake paint, and leather seats? Because my state allows only one policy, one that includes diabetes, cancer, heart disease, and a broad range of other add-ons, I can not afford coverage for anything - I am priced out of the market by the idea that everyone should have a Rolls-Royce or nothing at all. mike gray <omgray@worldnet.att.net> wrote on Mon, 27 Mar 2006 21:16:20 GMT: >> Yes, diabetes can be an expensive disease, but not nearly as expensive >> as many diseases/health issues that *are* covered. Moreover, we're >> talking about insurance here. If insurance companies can simply >> exclude every problem that is "inconvenient" for them, what's to >> prevent them from excluding cancer, heart disease, etc.? > Insurance companies should be allowed to offer different products to > the consumer, with the price reflecting the coverage. I disagree (although I'm not personally involved). The philosopy behind the requirement is that the health of each person is the concern of and responsibility of society, therefore society must somehow ensure people's health (here, through regulation requiring health insurance policies actually to cover common illnesses). > Would you like it if the state required all cars to have navigation > systems, metalflake paint, and leather seats? The first is actually becoming reality in Europe - in the form of a requirement for a device that transmits an emergency 'phone call (including GPS coordinates) in the event of a crash. No, I don't like it. > Because my state allows only one policy, one that includes diabetes, > cancer, heart disease, and a broad range of other add-ons, I can not > afford coverage for anything - I am priced out of the market by the > idea that everyone should have a Rolls-Royce or nothing at all. Your "because" is, in my opinion, mistaken. The reason you cannot afford insurance is because health care in the US is neither a free market, nor properly organized and regulated by government. In Western Europe, including Germany, nearly everybody has health insurance and can afford it, although the intrinsic costs are the same as in the USA. SignatureAlan Mackenzie (Munich, Germany) Email: aacm@muuc.dee; to decode, wherever there is a repeated letter (like "aa"), remove half of them (leaving, say, "a"). >>Insurance companies should be allowed to offer different products to >>the consumer, with the price reflecting the coverage. [quoted text clipped - 4 lines] > health (here, through regulation requiring health insurance policies > actually to cover common illnesses). If "the health of each person is the concern of and responsibility of society" we would not allow some 45 million citizens to be uninsured and, therefore, denied access to routine medical care. Since we (in the US) have chosen private sector coverage instead of (European) public sector coverage, we should at least allow private sector definition of benefits. If everyone in the tax base supports the system, then access and benefits should be universal and equal. If I have to pay out of my own pocket for my personal coverage, I should have the choice of what specific risks I want to take. > Your "because" is, in my opinion, mistaken. The reason you cannot afford > insurance is because health care in the US is neither a free market, nor > properly organized and regulated by government. That's a big part of the reason, but certainly not the whole reason. In Western Europe, > including Germany, nearly everybody has health insurance and can afford > it, although the intrinsic costs are the same as in the USA. The intrinsic costs in the US are quite a bit higher than in western Europe, primarily due to (1) much higher expectations in the US, and (2) the litigation costs when those expectations are not met. Personally, I would support a European-style health system in the US, but Medicare beneficiaries, union members, and government workers - all significant voting blocs - are strongly opposed, so it won't happen. Europeans have the advantage of having gone from nothing directly to universal state-funded systems without ever creating the caste system we have here. The US is doomed to forever bitch about what someone else gets that we want. The fact is this...our government must protect those that do not have the power to protect themselves. These state guidlines have been put in place to protect citizens and help to ensure that they are allowed to live healthy, productive lives. State's legislators KNOW that insurance companies, if given the ability, would drop coverage on those items that are the most expensive for the company. They also know the employers are, naturally, most often going to sign up for insurance plans that are cheap and don't cause too much of a financial strain. Diabetes care is expensive, yes, but far too many lives are at risk if states don't ensure that diabetes is covered across the board. mike gray <omgray@worldnet.att.net> wrote on Tue, 28 Mar 2006 15:13:06 GMT: >>>Insurance companies should be allowed to offer different products to >>>the consumer, with the price reflecting the coverage. >> I disagree (although I'm not personally involved). The philosopy >> behind the requirement is that the health of each person is the >> concern of and responsibility of society, therefore society must >> somehow ensure people's health (here, through regulation requiring >> health insurance policies actually to cover common illnesses). > If "the health of each person is the concern of and responsibility of > society" we would not allow some 45 million citizens to be uninsured > and, therefore, denied access to routine medical care. The practice clearly doesn't match this philosophy, though I believe that it is the driving force behind the regulation. > Since we (in the US) have chosen private sector coverage instead of > (European) public sector coverage, we should at least allow private > sector definition of benefits. Again, I disagree. Illness hits society at least as hard as individuals, so society should have a big say in how illness is dealt with. If insurance companies are permitted to omit diabetes from their policies, then the cost of diabetes will fall, one way or another, directly on the taxpayer. > If everyone in the tax base supports the system, then access and > benefits should be universal and equal. If I have to pay out of > my own pocket for my personal coverage, I should have the choice > of what specific risks I want to take. If you drive a car, you are obliged to have insurance for third party damage (at least, you are in Europe). There are limits on your freedom, since you are not the only person affected. >> Your "because" is, in my opinion, mistaken. The reason you cannot >> afford insurance is because health care in the US is neither a free >> market, nor properly organized and regulated by government. > That's a big part of the reason, but certainly not the whole reason. >> In Western Europe, including Germany, nearly everybody has health >> insurance and can afford it, although the intrinsic costs are the same >> as in the USA. > The intrinsic costs in the US are quite a bit higher than in western > Europe, primarily due to (1) much higher expectations in the US, and > (2) the litigation costs when those expectations are not met. Higher expectations? I doubt it. Higher litigation costs - so it would seem! But I wasn't really counting that as an intrinsic cost. > Personally, I would support a European-style health system in the US, > but Medicare beneficiaries, union members, and government workers - all > significant voting blocs - are strongly opposed, so it won't happen. > Europeans have the advantage of having gone from nothing directly to > universal state-funded systems without ever creating the caste system > we have here. Unfortunately it's going that way here, too. Slowly but inexorably. > The US is doomed to forever bitch about what someone else gets > that we want. SignatureAlan Mackenzie (Munich, Germany) Email: aacm@muuc.dee; to decode, wherever there is a repeated letter (like "aa"), remove half of them (leaving, say, "a"). hi i normally don't post in this group, but this kind of stuff makes me so mad, i am a diabetic on dissability, and i could never afford my medicine or testing stuff with out my health covergae for it, these people in government are clueless at times, they waste money on their high dollar saleries and wasting money in foreign countries and they don't seem to care about us in our won country how very sad! i am glad for the ones who do fight for us in goverment, sorry to ramble but this makes me so mad! >In a FEW SHORT WEEKS Bill called Health Insurance Marketplace >Modernization and Affordability Act (HIMMA, S. 1955) will come up for [quoted text clipped - 78 lines] >provide health insurance to their employees, we strongly believe that >this legislation is not the answer." If this lil baby passes a lot of people will be in the hurt. Stick prices at walmart have been increased recently. Maybe the stick manufacturers are getting ready to see an explosion in profits since everybody will be paying retail. The ebay supply will definitely disappear. This disease is about to get unbelievably expensive. |
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