Alabama lags behind nearly all states in requiring insurance companies to cover diabetic testing equipment, supplies and education to help diabetics to properly manage their disease. This deficiency wreaks havoc on the health and pocketbooks of many of the 439,000 Alabamians who have the disease.
The number of diabetics in Alabama will likely increase, according to Margaret Frentz, area manager of the Alabama office of the American Diabetes Association (ADA). She estimated one third of the state’s diabetic residents are undiagnosed.
There are four states in the United States that have not enacted diabetes insurance coverage laws, according to the ADA national office in Alexandria, Va. Alabama is on the list along with Idaho, North Dakota and Ohio.
According to the National Conference of State Legislatures, diabetes coverage laws were signed in 2001 in Michigan, Montana and Oregon, and Wyoming has recently signed diabetes coverage into law. In 2002 Georgia and Wisconsin expanded their existing diabetes coverage laws.
Mississippi, which ranks second in the nation to Alabama for percentage of diabetics in its adult population (10.3 percent), passed a diabetes coverage law in 1998. But Alabama, ranking first in the nation with 10.5 percent of its adult population being diabetic, has not passed any insurance coverage laws for diabetics, though bills have been presented.
To maintain tight control of the disease, diabetics must test their glucose levels multiple times a day. A diabetic places a tiny drop of blood on a test strip to determine a glucose result. That strip is disposed of and a new test strip must be used the next time.
Daily management of diabetes takes money that some medical insurance policies do not provide even though diabetics pay premiums like everyone else.
It is not unusual for Type I diabetics to not only pay their monthly insurance premium, but also the equivalent of anything from a used car note to a modest home mortgage payment for their insulin injection and glucose testing equipment, because the insurance is not required to cover these.
But even this expense would cost insurance companies less than complications from uncontrolled diabetes such as heart and kidney disease, stroke, blindness, amputations and neuropathy. Ironically, these are medical expenses that insurance companies usually will cover.
“There’s a ton of evidence that shows for every dollar invested in prevention through diabetes supplies and education, you can save the health care system $3 to $7 in treating complications,” said Pauline Ellis, director of programs and government relations with ADA’s South Coastal Region.
With medical complications factored in, the Center for Disease Control and Prevention (CDCP) says the total cost, direct and indirect, of diabetes in the United States is at least $130 billion a year.
This figure is due in part to the fact that it costs more to treat complications of diabetes than it costs for insulin, test strips and education to control it, thereby curbing complications.
Proponents of the diabetes coverage legislation in Alabama are seeking to require all state-regulated health insurance plans (any insurer legally doing business in the state) to provide comprehensive coverage for diabetic test supplies and self-management education as part of basic coverage at no additional cost to the insured.
ADA’s national plan called for passage of such legislation in all 50 states by the year 2003, but Alabama did not meet that goal. She said for the bill to have a chance in 2004, people in support of it must aggressively let their voices be heard by Alabama legislators and in particular the health committees of the Alabama House and Senate.
According to the Legislative Reference Service of the State of Alabama, House Bill 58 was introduced in the regular legislative session of 2001 and on Feb. 6, 2001, went to the committee on health, where it remained.
Sponsor of the bill, Alabama Rep. Mike Hill, district 41, said the bill was two votes short of passing out of the health committee, and that there has been no reintroduction of the bill to date.
A version of the bill saw some action in the Senate health committee in 2003, however, according to Dennis Pillion who is president of the ADA Leadership Council of Alabama.
“We reintroduced the bill as the Diabetes Cost Reduction Act of 2003,” Pillion said.
But the bill died in the health committee, after gaining a majority of the Senate health committee’s sponsorship. The bill was never debated or voted on by the Senate because a quorum of senators did not appear at a public hearing that was scheduled for May 2003, according to Pillion.
Pillion and numerous other supporters of the bill, including physicians and ADA administrators from the Washington, D.C. area had flown in to testify at the hearing.
“By increasing the spotlight on this problem they’re [Alabama House and Senate] going to have to do something,” Pillion said. “There’s a large number of folks in Alabama who have the disease, so Alabama ought to be the leader on where the most money is spent on helping people with diabetes have the lowest number of complications from diabetes,” said Pillion, who is a professor in the UAB School of Medicine’s department of pharmacology and toxicology.
Pillion and the ADA said the current cost of diabetes in Alabama is $3 billion a year.
He explained that this is not only medical costs, but also costs to businesses through lost productivity, employees’ time away from jobs due to illness, premature mortality, etc.
If the DCRA is passed, the costs of diabetes in Alabama could be reduced because the disease is highly controllable, but only when diabetics can afford to test more frequently, afford the medicines and afford to become better educated about their diabetes. All this can result in healthier workers in Alabama’s businesses, he said.
The ADA has a means set up for supporters of the bill to make their stance known to both the ADA and the Alabama Legislature, according to Ellis.
Supporters may call the ADA at 1-800-676-4065, Ext. 3019, or send an e-mail to makingnoise_al@diabetes.org, Ellis said.
“The reality is the fact that there is so much evidence that shows that this coverage will save money and improve the quality of life of thousands of Alabamians, while not raising insurance premiums,” Ellis said.
“If the Legislature sees fit to pass the law then we’ll enforce it,” said Michael Bownes, general counsel for the Alabama Insurance Depart-ment, a regulatory agency for insurance business conducted in the state.
“As a regulator, our position is to provide products that are available and affordable. We certainly want a provider to offer as many benefits as they can to the policy holder,” he said.
But, he said requiring coverage for diabetes or any other condition means that insurance companies would likely increase the amount policyholders pay for insurance. “You may also have companies that decide they can’t make a profit anymore,” he said.
“We want what’s best for the consumer, but if we’re in a situation where mandates cause the markets [companies] to leave, then we haven’t accomplished what’s best for the consumer,” said Johnny Johnson, Alabama’s deputy insurance commissioner.
“There is absolutely no evidence to show that this kind of a mandate raises insurance premiums,” Ellis said.
Research in March 1996 by the Maine State Bureau of Insurance found that, “Of the 15 insurers responding to our request for coverage information, most did not believe there would be an increase in premiums due to the proposed (diabetes coverage) legislation.”
However, some experts in the field remain unconvinced.
“They’re [the ADA] trying to get all insurers to do what we already do,” said Jim Brown, a senior vice president with Blue Cross and Blue Shield of Alabama. “I’m not aware of any deficiency in our coverage, as it relates to what they’re trying to get legislated.
“In general, we do not support mandated benefits. We think that benefit plans by design are not something that need to be mandated.
“We cover diabetes as a covered condition as we do other types of conditions. We also have a diabetes management program where we identify diabetics, and we assist the patients, their families and physicians in monitoring their condition.
“If anything we’re providing more management for diabetes than we do many other conditions, because it is easier to track, diagnose and then monitor the patient.”
For Alabamians whose insurance does not cover their supplies to test their blood sugar levels, Johnny Johnson said, “I would tell them to just let their voice be heard with the agencies and companies (for which they work). It’s just the way it is, as with anything — supply and demand. Eventually there will be someone who will supply coverage.”
Pertinent mostly to diabetics who are 65 and older, Medicare in Alabama includes coverage for diabetes testing supplies in its plans.
According to the ADA, some pharmaceutical companies have philanthropic programs, usually organized as a foundation of the company, that will provide insulin or oral diabetic drugs free of charge for a limited time. To participate, the person cannot have insurance, cannot have an income that falls below a threshold and must meet other criteria the foundation may require. The medications are routed through physicians that must recommend the patient for the program.
For the list of some of the participating pharmaceutical companies and more information about qualifying, check online at http://www.diabetes.org or call the ADA at 1-800-342-2383 and ask about a Diabetes Forecast magazine article in the October 1998 issue, titled: “Broke? Need Medication? Read On.”
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