Fighting The High Cost Of Diabetes For Patients

Posted: April 28, 1997

Health insurance pays for the daily doses of insulin that keep 9-year-old Alicia Ertle's diabetes under control.

But it doesn't pay for syringes to inject the insulin, or equipment to monitor her blood sugar, or even for the emergency medication she keeps with her in case she suffers a life-threatening plunge in blood sugar.

``It doesn't make sense to me,'' said Alicia's mother, Carolyn, from their home in Easton. ``It costs us about $135 a month out-of-pocket. We're among the lucky ones because we can afford it, but there are a lot of people who have a choice between buying food or medical supplies.''

Their problem would be solved if the Pennsylvania legislature passes a bill requiring private health insurance policies to cover all elements of managing diabetes, including medications, supplies and self-help educational programs.

House Bill 656, the uniform insurance coverage act, is part of a push at both state and federal levels to make coverage of diabetes consistent and comprehensive.

Twelve other states, including New Jersey and New York, have already passed legislation similar to the proposal in Pennsylvania. And for the second year in a row, Congress is considering legislation that would require Medicare, which covers the disabled and people over 65, to pay for diabetes self-management education and blood-testing supplies.

Behind the push for better coverage are two forces: the ever-growing number of diabetics in this country, and research proving that careful control of diabetes reduces costly complications of the disease.

``There is a severe emotional and financial toll on people with diabetes . . . when the complications of blindness, kidney disease, heart disease, stroke and amputations occur,'' Philadelphia physician Ann M. Craig said earlier this month at a rally for House Bill 656 in Harrisburg. She is vice president of the Pennsylvania affiliate of the American Diabetes Association.

Diabetes develops when the pancreas produces insufficient or no insulin, the hormone that controls the body's absorption of glucose, the sugar derived from food.

Type I diabetes, also called insulin-dependent or juvenile diabetes, is an autoimmune disorder. Sufferers must inject themselves with insulin one to four times a day and monitor their blood glucose levels using self-testing kits.

People with the less severe form of diabetes - called Type II, non-insulin dependent or adult-onset diabetes - often can control it with diet and drugs that stimulate the pancreas to produce more insulin. Still, about 40 percent eventually require some insulin to manage their illness.

More than eight million Americans have been diagnosed with diabetes - including about 800,000 with the insulin-dependent form - and another eight million people are undiagnosed, according to federal estimates. Pennsylvania alone has about 1.1 million diagnosed diabetics.

For unknown reasons, insulin-dependent diabetes is increasing worldwide. In this country, the non-insulin-dependent form is also becoming more common because the population is becoming older, fatter and more sedentary - key risk factors for Type II diabetes.

Although most health insurance pays for hospitalization to treat complications of diabetes, many policies skimp on the education and equipment that patients need to prevent complications.

``I get calls on a weekly basis from people who cannot . . . afford syringes or blood-sugar test strips that aren't covered'' by insurance, said Lisa Sloane, government relations manager for the diabetes association's Pennsylvania affiliate.

Advocates say that comprehensive coverage would actually reduce the staggering costs of diabetes, which consumes one of every four Medicare dollars, and one of every seven health-care dollars in this country. They cite a 10-year study recently published in the New England Journal of Medicine that found that stringent diabetes self-management reduced kidney disease, blindness and nerve disease - a leading cause of amputations - by more than half.

The diabetes association estimates that in Pennsylvania alone, comprehensive insurance coverage could save nearly $1 billion of the $6.7 billion spent annually on diabetes.

House Bill 656 is sponsored by Rep. Matthew Wright (R., Bucks County) and has considerable support, including that of Rep. Nicholas Miccozie (R., Delaware County), chair of the House insurance committee. The bill is expected to move out of committee next month, the first step toward its consideration in the House and Senate.

If it passes, Craig said, ``citizens . . . will benefit by saving precious health-care dollars.''

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