The senior author of the new paper, assistant professor of internal medicine Renuka Tipirneni, M.D., M.Sc., notes that before the pre-existing condition clause took effect in 2014, insurance companies could set higher monthly rates if they agreed to cover people with diabetes. They could also charge far more to people in their 40s and 50s; the ACA limited those rates to no more than three times what the plans charge a younger person.Ā
“For people with chronic health conditions such as diabetes, having insurance coverage can mean the difference between being able to afford crucial medications such as insulin, or getting sick and requiring emergency care,” says Tipirneni. Ā “As a physician, I know how important it is for patients with diabetes and other chronic health conditions to be able to take their medications and get regular check-ups — services made possible by affordable health insurance coverage.” Ā
The new study shows that people with complications of diabetes were more likely to obtain health insurance after the pre-existing condition clause took effect. One-third of people with diabetic complications, such as damage to their nerves, eyes or kidneys, obtained coverage after 2014, compared with about a quarter of those who were enrolled before 2014.
The ACA requirements regarding pre-existing conditions and limits on rate differences for people of different ages are among the issues being contested in a national court case. In 2018, the U.S. Department of Justice filed a brief stating that it would no longer enforce the ACA clauses known as guaranteed issue and community rating.
The guaranteed issue clause mandates that insurers offer coverage to people with pre-existing conditions, while the community rating requires insurance premiums to be affordable with adjustments only for age, tobacco use and geographic area.
The lawsuit over this matter, and over the constitutionality of the entire Affordable Care Act, is currently working its way through the courts. Called Texas v. United States, it is expected to reach the U.S. Supreme Court.
The study is based on nationwide data from 75 million people covered through a large insurer (the Clinformatics Data Mart Database) purchased by the U-M Institute for Healthcare Policy and Innovation, of which the authors are members.
Tipirneni cares for people with diabetes in her general medicine clinic at Michigan Medicine, U-Mās academic medical center, as does co-author Catherine Kim, M.D., M.P.H. Co-author Joyce Lee, M.D., M.P.H. specializes in caring for people with Type 1 diabetes. IHPI senior statistician Tanima Basu, M.A., M.S., co-authored the report.
The study was funded by the National Institutes of Health (TR000433) and by the Jaeb Center for Health Research Foundation (T1D Exchange).
Reference: American Journal of Public Health, DOI Ā 10.2105/AJPH.2018.304933, https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2018.304933