Monday, March 22, 2010

Just Because...

Lawmakers made Insurance Industry Reform History with a 219-212 vote on March 21, 2010. This may reshape how Americans deal with wellness and illness overall, particularly those of us in the Diabetes Community who have faced the arbitrary, profit-driven unfairness of our current health insurance industry.

To be clear: I don't understand much of this package, and do think there are good and bad elements in it that will continue playing out through the coming decade and beyond. In my eyes, this isn't a cure. Rather, it's possibly akin to the creation of home-use Blood Glucose Meters (widely inaccurate as the FDA is exploring, but still very essential in our daily lives.)

With that, I offer some coverage from the trusted Indianapolis Business Journal (Disclosure: my employer, though I work for its sister legal-newspaper) that has an ace health industry reporter covering this beat. Here are some highlights that I've taken from this, with my thoughts following in italics:
  • When the law takes effect, companies like WellPoint Inc. (Anthem, BCBS, & Others) will no longer be able to deny coverage to those with expensive medical conditions - the ever-crippling pre-existing clauses that we PWD know so well. These insurers will face limitations on how much more they can charge a sick person than a healthy one. By 2014, individuals will be forced to have insurance and companies will have to offer insurance—or else pay a fine.
    • First part, I completely agree with. Mostly for reasons that SixUntilMe's Kerri talks about today. It offers me a sense of relief, after a lifetime of fear and caution. Secondly, we can argue politically about the anti-capitalism theme and mandates on individuals... Not totally convinced on the merits, but I am trying to have faith that this will provide motivation for the insurance industry to make needed changes with us in mind. 
  • Expansion of insurance coverage will be paid for with a new Medicare payroll tax on individuals making more than $200,000 a year and families making more than $250,000. Much of the rest of the money will come from $12 billion a year in new fees on the health industry: Drugmakers will collectively pay $2.7 billion a year. Health insurers will pay $6.7 billion a year. And makers of medical devices will pay $2 billion each year.
    • Tax the rich. But that's not all. Then, tax everyone else who may not be rich but may be a consumer of devices such as insulin pumps or CGMs, drug-makers who will pass on these taxes as business production costs to the patient users, and private insurance carriers that will do the same and pass on these taxes to the insured.... Possibly resulting in people having less access, less affordability, and more people having to search for better insurance, or turn to these "high-risk pools," state-run exchanges, or govt-subsidized plans. Hmmm... Just don't know. This scares me. And believe me, I'm by no means anywhere in the rich bracket. Nor do I have anything like a Cadillac Plan that will face a similar issue.
  • More people with insurance is good news for just about every sector of the health industry. It should mean fewer unpaid bills at hospitals and more customers available to doctors. It also means more people will be able to afford expensive prescription drugs, such as those made by Indianapolis-based Eli Lilly and Co.
    • This makes logical sense to me. And That Is All.

  •  The bill creates a pathway for generic versions of biotech drugs to come to the U.S. market for the first time. However, Eli Lilly and its Peers successfully lobbied for 12 years of exclusivity on their biotech drugs, a big increase from the 5 they currently enjoy on chemical pills. Patents can extend those periods of exclusivity even longer.
    • I think I agree with this, because my mind goes to the generic possibilities that might make brand name-makers more mindful of the costs. Plus, generic insulin = Yes, Please!
In the end, I have Hope & Faith that this is a starting point that will lead to Change. As the ADA puts it in their reaction to the House-passage of this hcr:

“Today is a day for celebration for the 23.6 million American children and adults who are living with diabetes. The passage of health reform.. finally tears down the wall that keeps people with diabetes from the health care they need,” said ADA board chair Nash Childs. “With the passage of health reform ‘just because you have diabetes’ will no longer be a lawful excuse to deny coverage, to charge exorbitant rates, or to take away care just when a person with diabetes needs it most. It gives all Americans with diabetes a fighting chance at controlling this devastating disease before they face blindness, amputation, heart disease, and kidney failure."
 
That arbitrary insurance theme of denying us "Just Because" They Can haunts me; it's haunted me ever since I've been old enough to know what was happening. This this is a start. I do worry about the hidden costs and impacts of this, but that uncertainty is anything but certain and could not even exist. With this, I feel like I'm an American whose voice HAS BEEN HEARD that something had to be done. (Yes, there were these voices out there! Oh my!) Now, I hope that the industries that make decisions about my Quality of Life will also hear my voice on this and not just go about their business as usual without listening. THAT is the reform we need in this country, and to me this represents a step in that direction.

2 comments:

Rachel said...

If you read the book by T.R. Reid, The Healing of America, he gives background on why there must be individual mandates to make a the system work properly.

And hopefully, this will give the pharma/medical device companies some thought into lowering prices and cutting costs in production rather than passing along the cost to the patient consumer. Ahem, like glossy marketing materials sales reps get to hand out to potential hospital/physicians/patients.

Wendy said...

Yeah...I "went there" on my blog too...but I'm just a mom who probably doesn't know squat.