Four ways the ACA drives higher-value diabetes care

May 28, 2016

Specific benefits patients with diabetes have experienced due to the ACA, and how those benefits are impacting diabetes costs.

Many people with diabetes benefited from the passage of The Affordable Care Act (ACA). This is because it improved their access to care, lowered their medical costs, and improved their treatment, says Derek S. Brown, PhD, assistant professor and health economist at Washington University in St. Louis, Missouri.

Here are a few more specific benefits patients with diabetes have experienced due to the ACA:

  • Improved coverage. For individuals who have private health plans under the ACA, screening for an initial diagnosis of diabetes is now covered as a mandatory preventive service without any cost sharing.

  • More insurance protections. For individuals who change plans, switch jobs, or have a gap in coverage for another reason, the ACA prohibits denial of coverage (or higher premiums) due to pre-existing conditions. “This is a huge benefit for people with diabetes, many of whom might have been denied coverage or charged extremely high premiums in the past,” Brown says.

  • More access to insurance. The number of uninsured individuals has significantly decreased nationwide, especially in states that expanded Medicaid. “This means that many people who did not have access to care in the past because they lacked insurance (and therefore, a way to pay for care, and oftentimes access to a physician network) can receive the medical care that they need,” Brown says, adding that this is especially important for diabetes management and treatment.

  • Fewer coverage gaps. Provisions in the ACA have largely eliminated the previous concern of underinsurance, i.e., having health insurance but being subject to coverage gaps and provisions which weaken the protections and value of insurance. “This was especially true on the open market, which has been replaced by the ACA exchanges found at healthcare.gov,” Brown says. People with diabetes, for example, may have had limitations on the number of prescription fills or hospital stays.

All that being said, some gaps still exist. States that did not expand Medicaid have significant numbers of uninsured individuals, including many with diabetes. In addition, the ACA does not protect some other segments of the population such as undocumented immigrants, who have health needs including diabetes.

Impact on costs

Although scientific evidence is limited on this topic, the ACA has plausibly reduced healthcare costs for many people with diabetes because of the same reasons that it has improved access to care.

In the past, uninsured people with diabetes often had difficulty paying for medication or medical care, as reported in Preventing Chronic Disease. “Because more people are now insured, many are able to get the care they need at lower total costs,” Brown says.

For people with diabetes who had good health insurance before the ACA, their costs have probably not changed very much, and may have increased. “This is not so much due to the ACA, but rather because of broader trends across all health insurance products toward greater cost sharing, tighter formularies, narrower provider networks, and higher prescription drug costs,” Brown says.

Next: Impact on diagnoses and treatment

 

 

Impact on diagnoses and treatment

It is highly probable that the number of individuals diagnosed with diabetes will be greater for several years because of the ACA’s impact on improved access to care and its requirement to cover preventive services with zero cost sharing, which includes screening for diabetes.

“Over time, detection rates should stabilize and may even be lower in the very long term if the ACA improves preventive health in general enough,” Brown says.

For people who were previously uninsured or underinsured, the ACA should have significantly improved their treatment and care of diabetes because of improved access, fuller coverage, and better affordability. People who had good health insurance in the past will not be significantly impacted.

For the entire population of Americans with diabetes, the ACA brings significant improvements, Brown concludes. Access to care has improved, and the quality of insurance plans has improved through more complete coverage and fairer rules.

Before the ACA, millions of people who had diabetes were undiagnosed; many of them were uninsured. “If someone doesn’t know that they have diabetes, they can’t control it,” Brown says. “Many of these individuals experience preventable, damaging complications.”

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.