Insurance Rules Can Frustrate Diabetes Patients

Feb. 8, 2005 -- The U.S. health insurance system may be failing to provide adequate coverage to millions of people with diabetes, a report issued Tuesday concludes.

The study warns that while most private and public health plans include preventive services and treatment for diabetes, patients who lose insurance or try to switch plans are often confronted with raised costs that price them out of new coverage.

The result may be that patients are left to shoulder the full cost of paying for daily blood sugar monitoring, insulin, and preventive care that most people with diabetes need to reduce the risk of serious complications, the study's authors say.

More than 18 million Americans have diabetes, with an estimated 41 million more at risk for the disease.

"Pretty much, diabetes is uninsurable," says Karen Pollitz, a health policy researcher at Georgetown University, which conducted the study along with the American Diabetes Association, an advocacy and lobbying group.

Researchers at the group investigated 851 diabetes patients who contacted a call center to complain about problems with their health insurance. Many had been insured but lost traditional employer-sponsored group coverage because of a job change.

Nearly 400 of the callers tried to buy individual insurance. Many could not find an insurer who would take them, and those who did often confronted raised premiums and restrictions that excluded any diabetes-related care for a year or more. Only 15 of them eventually bought coverage, according to the report.

A federal law called COBRA allows insured people who lose or change jobs to continue buying coverage as long as they pay for it themselves. But only 31 of 377 eligible for the coverage chose to take it because of cost restrictions.

Many states have publicly-funded risk pools designed to provide insurance costs for people without coverage, but exclusions and coverage limits meant that only seven patients took advantage of them.

Pollitz stresses that these were individual case reports and "you can't generalize these results to the whole population." But she says they are illustrations of how problematic finding adequate coverage can be for people with diabetes.

ADA officials say they are lobbying state and federal lawmakers to enact subsidies designed to help diabetes patients pay for the costs of joining private insurance plans or state-funded risk pools.

Karen Pisano, a spokesperson for America's Health Insurance Plans, a medical insurers' lobbying group, says that insurance plans actively promote diabetes care and prevention for members. But she also acknowledges that finding affordable policies can be difficult for patients who lose coverage.

"There are subsidies and tax credit kinds of possibilities that we would advocate strongly," Pisano says.

Excluding or restricting coverage for high-risk people is a standard practice across all forms of insurance. Companies that readily take on already sick patients confront much higher costs that must be spread throughout the entire insured group. Plans that want to cover existing diabetes on a par with other illnesses do so at the risk of attracting many people with the disease, making it potentially impossible to manage the risk of paying for their care, Pollitz says.