For far too long, people with diabetes were denied health insurance outright because of their diabetes or required to pay an exorbitant amount for health insurance coverage. The Patient Protection and Affordable Care Act (ACA), signed into law in March of 2010, provided comprehensive health reform in the United States and brought important changes to our healthcare system that were long overdue. The law has improved access to and the affordability of health insurance for individuals and families.
For the millions of people with diabetes and those at risk of developing it, the ACA provides access to quality healthcare that is vital to the prevention and management of diabetes and maintaining overall health.
The ACA provides essential insurance reforms designed to make adequate and affordable health insurance accessible to nearly all Americans. Many provisions in the ACA benefit people with diabetes:
• Protects people with diabetes who, prior to the ACA, were discriminated against because of their disease when they sought health insurance
• Eliminates annual and lifetime dollar limits on health insurance coverage
• Prohibits insurers from charging people more for insurance based on their health or gender
• Provides access to free preventive care
• Allows young adults to stay on their parent’s insurance plans up to age 26
• Lowers prescription drug costs for seniors
• Established the National Diabetes Prevention Program, a successful program aimed at preventing type 2 diabetes
The ACA established a Health Insurance Marketplace in every state. Here, individuals and families can shop for and buy health insurance. To help pay for monthly insurance premiums, financial assistance—through a tax credit—is available for people who meet income requirements. In addition, some low- and moderate-income individuals are eligible for other assistance to lower their out-of-pocket costs when they access healthcare.
Prior to the ACA, even people with insurance faced barriers to managing their diabetes since insurance plans didn’t necessarily cover the most basic diabetes needs. The ACA established a minimum set of Essential Health Benefits (EHB), which include hospitalization, chronic care management, prescription drugs, and preventive services, that must be covered in all plans sold in the state marketplaces and also in some plans available outside the marketplaces. The ACA also established an annual out-of-pocket maximum for marketplace plans to help protect consumers from large medical bills. Finally, the law gave states the option to expand their Medicaid program to all Americans under age 65 whose family income is at or below 133 percent of federal poverty guidelines.
Supreme Court decision
The Supreme Court ruled 6–3 in King v. Burwell, a landmark ACA case, ensuring that residents in all 50 states are eligible for health insurance subsidies. The decision ensures that 6.4 million Americans in the 34 states that utilize the federal marketplace will continue to receive financial assistance to make health coverage affordable. View the ADA press release.
The ACA has greatly reduced the number of uninsured Americans and has improved the affordability of insurance for millions. However, more education is needed so people fully understand the benefits and requirements under the law.
The ACA did not create a perfect healthcare system; people with diabetes still face obstacles when trying to access insurance coverage and care. But for millions, the law has brought real, positive change to their lives and their ability to manage their disease.