Health Insurance and Diabetes

Between March 2003 and June 2004, the American Diabetes Association (ADA) and researchers at Georgetown University's Health Policy Institute completed a project that examined through individual case studies the availability, affordability, and adequacy of health insurance for people with diabetes.Over the course of the project, caseworkers and researchers took calls from 851 people who contacted the ADA national call center (1-800-DIABETES) because they had health insurance problems.

The majority of cases studied involved problems with private health insurance because this is how most nonelderly Americans obtain health coverage. Some problems related to public coverage were also studied, however. Calls were accepted from people who were younger than age 65 and who were either uninsured, transitionally insured with coverage that was about to end, or insured with other problems. Information about people and their insurance circumstances was recorded in a database. Callers were also asked whether they would be willing to share their stories, and two-thirds said yes.

The focus of this project was on diabetes because the condition is so prevalent, and health insurance is essential to managing diabetes effectively. The U.S. faces an epidemic of diabetes, a disease in which elevated blood glucose levels damage nerve endings and blood vessels, leading to serious health complications including blindness, kidney failure, heart attack, and stroke. Today, an estimated 18 million Americans have diabetes, and 1 million more are diagnosed each year^.

Diabetes can be effectively managed, but medical care and supplies needed to monitor and control blood glucose levels are expensive. Numerous scientific studies have found that health insurance problems make it harder for people to manage their diabetes, often with devastating consequences. Just the routine costs of managing diabetes (to test and control blood glucose levels) can reach hundreds of dollars per month Uninsured adults with diabetes are far less likely to receive needed care and effectively manage their disease, and those with health insurance have difficulty obtaining needed care when coverage is inadequate.

The stories featured here are consistent with these findings and demonstrate what can happen to people who are sick when their health coverage breaks down. Case studies of health insurance problems do not present a complete picture of the health coverage system. However, just as automobile safety experts study data from car crashes for clues about how to make the roads safer, examining the health insurance problems of people with diabetes yields important clues about how to make coverage work better when it is needed most.

Project staff worked with callers to try to resolve their health insurance problems using available resources under federal and state law. Options under employer-based coverage, individually purchased insurance, and public programs were explored. The vast majority of problems could not be resolved because there are not enough safeguards to guarantee available, affordable, adequate health coverage for all people in the United States, regardless of their circumstances. In some cases, people had tried so long without success to find health coverage that they finally gave up on the system altogether. Convinced they would never be able to find affordable, adequate health insurance, these discouraged uninsured individuals no longer sought insurance coverage, but instead only charity care.