Will diabetes patients benefit from the Affordable Care Act?

The Affordable Care Act (ACA, also known as Obamacare) is dramatically changing health care delivery in the U.S. Specific parts of the new law, which will be phased in through 2020, will have a significant impact on patients with diabetes and prediabetes, as explored in a comprehensive Review article published in Diabetes Technology & Therapeutics (DTT).

In "Diabetes and the Affordable Care Act," Mark R. Burge, MD and David S. Schade, MD, University of New Mexico School of Medicine, discuss the aim of the ACA to overcome specific deficiencies in the current health care system and how the changes will affect individuals with diabetes. Following a detailed overview of the ACA, the authors detail items within the law that are of special benefit to patients with diabetes. These include the ultimate closure of the infamous Medicare Part D "donut hole"—a gap in prescription medication coverage that mainly affects seniors, causing them to incur substantial out-of-pocket expenses.

Another important feature of the ACA is its non-exclusion of pre-existing conditions provision. With this provision, for example, people with type 1 diabetes, and many with type 2 diabetes, who would probably be unable to purchase health care coverage on the individual marketplace due to a pre-existing condition exclusion, are ensured access to coverage under the ACA. Other advantages of the ACA include a prohibition on limiting lifetime/annual essential health benefits and the ability of young people to stay on their parents' insurance plans until age 26.

Prevention is also a key aspect of the new law, as the ACA provides certain preventive services at no cost. Of particular benefit for individuals with diabetes are pneumococcal and influenza vaccines, depression screening, and preventive tooth care for children. The ACA also authorized the creation of the National Diabetes Prevention Program at the Centers for Disease Control and Prevention (CDC), which is intended to deliver to communities evidence-based lifestyle change programs for preventing type 2 diabetes.

"The ACA may be an important step toward achieving improved diabetes care resulting in better long-term outcomes," says DTT Editor-in-Chief Satish Garg, MD, Professor of Medicine and Pediatrics at the University of Colorado Denver. "With improved glucose control, a better understanding of the disease, and improved therapeutic options, people with diabetes are living longer, and the ACA may not have accounted for the enormity of the potential cost burden this presents. Additionally, it is important that the ACA includes coverage for new and emerging therapies and technologies to ensure that all patients have equal access based on their individual needs."