How the Senate Obamacare Repeal Bill Would Impact People with Diabetes

Insurers may be allowed to not cover essential health benefits like drug costs, according to initial reports.



Developing Story

Under Senate Republicans’ draft version of what was previously known as the American Health Care Act (AHCA), people with diabetes would not be charged more in premiums because of their preexisting condition. However, the plan gives states the option to allow insurers to opt out of providing essential health benefits with their plans.

In other words, the legislation, now dubbed the Better Care Reconciliation Act of 2017, creates the possibility of a scenario in which a person with Type 1 could get insurance at the same rate as the general population, but the insurance plan he or she is covered under may not pay for insulin.

That is an early takeaway of initial reports by the New York Times, the Washington Post, and Politico of the Senate plan which was unveiled on Thursday after weeks of secrecy. The proposed legislation was crafted by a small team of Republican Senators and aides in a process that left Democratic lawmakers and even some Republican senators in the dark. The legislation is reported to be not substantially different from the House version of the AHCA, which passed in May.

It appears that the Senate version of the bill attempts to mitigate some of the harsh edges of the House bill, which has drawn fierce public opposition particularly because of how it handled those with preexisting conditions like diabetes. The House version includes the so-called MacArthur amendment, which would allow insurers to charge higher premiums for those with preexisting conditions. Like the Senate version, the House bill also would allow states to cut what are characterized as essential health benefits, or minimum services that a health plan must cover; essential health benefits can include everything from drug coverage to maternity care.

Read more: What the MacArthur Amendment Means for People with Type 1

The MacArthur amendment was included in the House bill to win votes from the more conservative members of the Republican caucus in that chamber. According to media reports, Senate Majority Leader Mitch McConnell (R-KY) is trying to walk a delicate line in an attempt to appease both the conservative and moderate wings of the Senate Republican caucus. The ban on higher premiums for those with preexisting conditions appears to be a concession towards moderate Republican senators, while an end to essential health benefits protection appears to be a concession toward the conservative wing. Facing uniform opposition from Democrats in the Senate, Republicans must vote as a unified block in favor of the bill for it to pass, and Senator McConnell has only three votes to spare among his caucus.

Read more: Your Preexisting Condition is Probably Your Fault: Congressman

In a move that also will impact thousands with diabetes, both bills would dramatically reshape Medicaid. The Senate bill provides a longer timeline than the House bill for the wind-down of the Medicaid expansion that occurred under the Affordable Care Act, but they both change the funding for Medicaid provided to the states from open-ended to a fixed budget.

The Affordable Care Act, which this legislation would repeal and replace, was the first national legislation which barred insurers from charging more for preexisting conditions; it also was the first national legislation to set the standard for essential health benefits.

It is believed that Senator McConnell wishes to bring the repeal-and-replace legislation to a vote sometime early next week. Insulin Nation will continue to report on this story as developments arise.

You can read the text of the bill here: https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf

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Craig Idlebrook is chief editor for Insulin Nation and Información Sobre Diabetes, and was founding editor for Type 2 Nation. You can reach him at cidlebrook@selfrx.com.