Why Essential Medical Services need to be protected
Why Essential Medical Services need to be protected
Essential medical services is kind of important in my world. Because I may live a very miserable 48 to 72 hours without Insulin.
Essential medical services really means keeping the person alive. When I first found out I was on insulin for the rest of my life, the experience was pretty bad. I had a trip to the ER, a weekend thinking all was ok, then I went back to the ER and spent five days in the hospital. Day 1 and 2 was in ICU, intubated. All I remember about those five miserable days were a super nice male nurse saying he would take care of me, and my parents coming home from Europe only to jump in the car and drive to the hospital. Because some random virus smoked my pancreas and thyroid. Then learning to give myself shots. Good times.
And my issue with the HHS decision to cut essential medical services is not just about me and my Type 1 peers. It is about my friends who are having babies and who lose guaranteed coverage. Or my friends who have kids with asthma. Inhalers like insulin are really expensive. The ones that actually work are tier 2 or 3, or off formulary. Which means inhaler or pay the electric bill this month. In the current medical system, the cost of meds is too damn high.
I am blessed to have a job with good benefits and be able to connect the underserved with benefits. And I do not speak for my employer. Just wanted to put that out there. This is very personal. The American Diabetes Association issued a press release here.
Today, the American Diabetes Association (ADA) expresses disappointment with the Notice of Benefit and Payment Parameters for 2019, announced on April 9 by the U.S. Department of Health and Human Services (HHS), which moves forward with changes that weaken rules requiring certain health plans to cover a minimum set of “essential health benefits” (EHBs). The changes allow states and health insurers to scale back coverage of EHBs, which include prescription drugs, preventive services, chronic disease management, hospitalization, maternity, and newborn and pediatric care. This final rule allows states to redefine EHBs and/or give insurers flexibility to avoid covering benefits that are necessary for people with pre-existing conditions including diabetes.
In other words, insurance does not have to cover essential care. The stuff keeping us alive kind of care. Nice.
Five hundred dollars a month for the pump and supplies. Six thousand dollars a year. With insurance. The cash price is significantly higher. Not including doctor visits, labs done three or four times a year and more. And pumps are replaced about every 3-5 years. They cost between $6,000 and $10,000. Per device. This means living paycheck to paycheck. And hoping the pump is covered. Cash prices are out of control.
So here are my three reasons why essential medical services need to be left alone:
Reason number one: Sane people in both parties agree that medical costs are hellish. And this is not a partisan issue. It is also not the pharmacist at CVS or Kay’s Pharmacy or WalMart driving the prices up. It is manufacturers and a reimbursement system that is ironically one of the most regulated markets out there. Medicaid and Medicare don’t help.
Reason number two: Managing essential medical costs means making hard choices every day. I switch glucometers based on which one my insurance has cut a deal with. And same goes for insulin. If I was underinsured or uninsured, the cost would be something like my annual net income plus. For medication, supplies, lab visits and doctor visits. Just for me.
Earlier this year, drugmakers Eli Lilly and Novo Nordisk boosted their insulin list prices by almost 8 percent. The American Diabetes Association said the average price of insulin nearly tripled between 2002 and 2013.
And the price keeps going up and up for short acting and long acting insulin. Cash prices and prices with insurance are frankly too damn high. IF HHS Secretary Azar does do something to control prices, I will happily retract the ire towards the man. But for now, the fox appears to be running the chicken coop.
Reason number three: This is not Viagra. Or birth control. These are medications literally keeping us alive. Ask a parent with a nut allergic or bee allergic kid where the EpiPen is.
Without making changes to malpractice suits or drug price fixing, simply ending protections for essential medical services is a very bad idea. See, chronic medical conditions are life long and can be managed, but the cost of staying alive makes it harder to manage said condition. Because you are taking less pills or insulin. So the lights stay on and you have a roof over your head. Or you are not getting the inhaler that works best. Or the EpiPen.
“All people living with diabetes should have access to comprehensive health insurance that includes coverage for the care necessary to successfully manage their disease and avoid costly, and life-threatening, complications,” said ADA’s Senior Vice President of Government Affairs and Advocacy LaShawn McIver, MD, MPH. “The changes issued by HHS put Americans with diabetes at risk, and it is our mission to continue to advocate on their behalf. ADA is committed to continuing our advocacy work at the state level to maintain or improve, not reduce, coverage of essential health benefits for people with diabetes across the country.”
The key phrase is “have access to.” This is not single payer. This is not universal health care. It is as simple as being able to afford medication. Do I want the FDA to do their job and reign in insulin costs? You can bet your life (I am betting mine) on that. Do I want insurance reform? Absolutely, and I want to see something happen with cost of medications and supplies that actually works. And lasts more than a press conference. Both parties own this.