Diabetic Math: What the GOP “Plan” Looks Like For a Person with Diabetes

As I well knew, the GOP “plan” for replacement falls way short.  Really, all it’s doing is returning us to Pre-Obamacare error health insurance industry with only two differences:   a tax credit for insurance and a tax on “Cadillac plans”.

Yeah.. Pretty much a big fat nothing of a plan.

But let’s put it into real world numbers. First, here are some of the points of the “plans” outline:

  • No more mandate
  • 30% surcharge on premiums if you lapse in insurance for up to 1 year
  • No more subsidies (which in the ACA was the premium subsidy and the cost sharing subsidy calculated by income)
  • $2,000 tax deductible for those under 30, double for those over 60.  In between is still not known (but likely to be less)
  • No protections currently in the ACA for pre-existing condition clauses
  • High risk pools with some money to states to help “some” with pre-existing conditions
  • Insurance allowed to charge 5x’s more based on age

What Does High Risk Pool Mean

High risk pools existed prior to the ACA in 25 states.  Characteristics of High risk pools:

  • Premiums were above standard premium prices (non medically underwritten) and States capped the premiums at 100 to 200% of standard.
  • Pre-existing conditions at enrollment were excluded from being covered for 6 to 12 months.
  • Lifetime and annual limits were set at around $1mil to $2mil. Some pools imposed yearly limits  on all covered services, some on specific benefits like drugs, etc.
  • Deductibles  for High Risk pools were often high at $5,000 or above (varied state to state).  Some deductibles were as high as $25,000.

Applying the numbers

Since some of the details are sketchy, there will need to be some assumptions to see the real world effect.

I have a Silver Plan that I purchased through the Marketplace that covers just me (my son has Chip).  I receive subsidies for premiums and I get cost sharing subsidies that reduces my deductibles and reduces the max out of pocket I need to hit before all medical is covered 100%.   Assuming that the “standard” will remain the same, the plan I currently have has the following costs without subsidies:

  • Premium = $551.57
  • Deductible = $6618.84
  • Max Out of Pocket $7150.00

Assuming High Risk Pools are capped at 100% and the deductible will go up – to say $10K (given where deductibles were for high risk pool plans prior to the ACA, the $10K number is being conservative)

  • Premium = $1103.14
  • Deductible = $10,000
  • Max Out of Pocket = $14,300 (assuming they double it)

Total yearly for premium = $13237.68

Knowing what the costs are for all my medications I know I will more likely hit the deductible.

Total Cost with Premium and Deductible = $23,237.68.

Tax credit  (assuming it’s $2,000)         =       $21,237.68

Now, diabetes costs me $19474.27 a year if I were to pay out of pocket with no insurance and $14,791.72 with the uninsured program from the insulin pump program that I calculated on this blog.

Basically, having insurance WITH the tax deduction will cost me MORE money than NOT having insurance and paying for diabetes supplies.  Only problem is, I can’t afford the cost of my diabetes in either scenario. The ACA subsidies is what made it possible for me to have insurance.

So, what are my options?

One thing is clear. I definitely can’t afford to HAVE insurance under the GOP’s plan.   So here are my options

  1. Go without insurance and PRAY I don’t have anything major happen. This is a scary though considering that I had, in the last 2 years, 3 torn meniscus repair surgeries and currently my right knee is not doing so well.   I may need to get that knee surgery in while I still have insurance.  That, and I’m getting older.  Anything could happen
  2. Start traveling to Canada for my prescription drugs.   – THIS is a real possibility. I live about 6 hours from the Canadian border.  Assuming I can get a script to a Canadian pharmacy, I could fill the scrip there and travel across the border.  According to some research, as long as the amount doesn’t exceed 3 months supply and I have a script for the drugs crossing the border, I should be okay.  It would be cheaper for me to spend the gas, drive and stay overnight at a hotel and pick up 3 months (9 vials of insulin) at $38 a vial.  It would cost me $342 for the insulin. Assuming gas and hotel would cost me another $300, we’re looking at a savings of  $2373 every three months or $9492/year.   If I did this my yearly medical cost to maintain my diabetes would be $5299.72.  This is assuming I could make the entire going to Canada thing work.  Pretty sad that I would have to do that.
  3. Assuming that #2 is workable Catastrophic coverage?  – would I be able to buy a catastrophic plan to cover an emergency condition if something were to happen? The question would be a) does my pre-existing condition preclude me from any kind of plan of that nature and b) would what is consider “catastrophic” be limited . By this , I mean would it exclude any complications that could arise from being a diabetic.  That remains to be seen.

Basically, the GOP plan pretty much screws me and people like me.  I’m one of the lucky ones, I won’t die – at least not immediately, although not being able to afford my care will compromise my health that could lead to complications that will kill me.  But others, their lack of access WILL kill them within weeks or even months, depending on what kind of condition they are being treated for.

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