Under the Affordable Care Act, insurers must now cover many preventive health services, such as diabetes screenings, often at no cost to the patient. And of interest to people with chronic conditions such as diabetes, the law bars lifetime caps on coverage.
    Kicking off the Diabetes Exposed event Saturday morning, keynote speakers Paul Ferguson and Dr. Brian DeLoach outlined these and other “Obamacare” benefits. Ferguson is director of Georgia Southern University Health Services, where DeLoach is the chief of medical staff. With support from local sponsors and health care providers, the American Diabetes Association hosted the half-day health fair at the Boys & Girls Club of Bulloch County headquarters.
    “While the Affordable Care Act — in many ways some people don’t like it — in terms of preventive care and primary care it does have provisions that are very supportive of both dealing with pre-diabetics and preventing diabetes, but also dealing with patients who have full-blown diabetes,” Ferguson said.
    President Barack Obama signed the act into law in March 2010, but parts are being phased in over an almost 10-year span. Under “Patients’ Bill of Rights” provisions, among the first to take effect, insurance companies are prohibited from denying coverage to children because of a pre-existing condition such as asthma or diabetes or from canceling anyone’s coverage by finding a mistake in their paperwork after they get sick.
    A ban on rejecting adults because of pre-existing conditions will only become mandatory next Jan. 1, but Ferguson noted that many insurers already have voluntarily complied.  Also effective in 2014, health insurers will be barred from charging different rates for men and women.
    “Insurance companies won’t be able to charge women more than men and they did that mainly because women’s health care is typically more expensive,” he said.
   
Covered screenings
    Provisions requiring that new policies cover preventive services without a deductible, coinsurance or copay took effect by Sept. 1, 2012. Covered screenings, as Ferguson displayed in a slide, include:
    Diabetes screening,
    Cancer screenings such as mammograms and colonoscopies,
    Vaccinations such as flu, meningitis and hepatitis B,
    Blood pressure and cholesterol screening,
    Depression screening.
    A full list can be found at www.healthcare.gov/prevention.
    In an interview, Ferguson said he thinks some aspects of the Affordable Care Act are excessive. But he told Diabetes Exposed participants that the preventive care provisions should make sense to people regardless of their politics.

‘First-dollar’ coverage
    The fact that “first-dollar” coverage is required is also important, he said, because copay costs that could be as high as $50 or $60 would prevent many people from getting tested. Screenings and other preventive steps, Ferguson said, save money in the long run, because without them, the disease progresses while costs of treatment rise.
    “Then someone pays those costs,” he said. “If they’re not on insurance, someone pays those costs, typically us, because the hospital has to increase the cost to see those patients gratis.”
    Limitations on coverage of certain medications and devices, including insulin and insulin pumps, also have been eliminated under the law, Ferguson said.
    Another Obamacare rule requires that health insurance companies justify increases in premiums for existing policies. Ferguson saw this in action recently when he served on a committee that wrote the proposal request for the University System of Georgia’s new five-year health insurance plan for all 32 schools. Tracking the law, the committee built in wording requiring that any increase in premiums be justified.
    “That doesn’t mean that they can’t increase the premium, but it has to be justified, and it has to be based in what they are paying to the actual patient and not to what they’re paying the CEO,” he explained.
    DeLoach, GSU Health Services’ lead physician, related the improved access to screening and prevention programs to whether diabetes — particularly type 2 diabetes — can be prevented.

Diabetes prevention
     “Can we prevent diabetes?” DeLoach asked. “The answer is a resounding ‘yes.’ We know from good data, population-based studies, that diabetes can be prevented, and it’s simple. It’s a very simple formula that is just hard to put into practice.”
    The formula, as he explained, has four elements: exercise, weight loss, education and screening.
    A 3 percent to 5 percent reduction in total body weight can help prevent the progression to pre-diabetes or from pre-diabetes to diabetes, he said. Guidelines published by the ADA recommend a minimum of 30 minutes of aerobic activity, which DeLoach said can included walking, at least five days a week.
    Screening, he said, is critical because it helps motivate lifestyle changes.
    “A lot of times people are not going to be motivated to do those first two things unless they know they’re already at risk,” DeLoach said. “But by screening for diabetes, recognizing people early on who are pre-diabetic or at risk of becoming diabetic and then incorporating that exercise and weight loss aspect into the equation, we know that we can help prevent diabetes.”
    Also folded into the Affordable Care Act, the National Diabetes Prevention Program authorizes the Centers for Disease Control and Prevention to create a network of programs in each state. DeLoach said that a funding method was not provided and that some private organizations, such as the YMCA and United Healthcare Group, have taken the lead.
    Georgia’s state program, he said, is “in the very early stages.” He referred people to the state coordinator, Dwana Calhoun, and the website www.health.state.ga.us/programs/diabetes.
    Ferguson and DeLoach’s primary mission is providing health care to students at the GSU Health Center. But they observed that the university has many students older than 21, or even the 26-year-old limit to which children can remain on their parents’ health plans under the Affordable Care Act. Ferguson said younger students also are arriving with pre-diabetes or diabetes or habits that can lead to these.
    Lifestyle education, DeLoach said, should begin much earlier.
    “I’m talking about kindergarten, elementary school, middle school,” he said. “Just like my generation grew up hearing that cigarettes are bad for you, this generation needs to grow up hearing that not exercising, eating the wrong kinds of foods and becoming overweight is bad for you.”
    Besides free blood sugar and blood pressure screenings, weight checks and body mass index calculations, Diabetes Exposed offered short courses in diabetes-related topics. These included healthy eating, foot care, exercise and fitness, the risks of blindness and pre-diabetes. About 35 to 40 people attended, said Allison Rollins, a graduate assistant with the American Diabetes Association who helped organize the event.