Diabetes Self-Management Blog

What’s your biggest diabetes fear? Complications are scary, but for many, the biggest fear is that diabetes will reduce them to poverty. Others fear that they don’t have enough money for good care or needed supplies.

In America, most people can’t pay for diabetes care without some kind of health insurance. Finding decent insurance can come to rule people’s lives. “I have had diabetes for 55 years,” wrote an anonymous commenter on a recent blog entry by Meagan Esler. “I have spent the majority of my life worrying about insurance coverage. It has impacted every job choice I have ever made. I never had the luxury of picking a job I might enjoy. I had to take whatever job had the best insurance.”

Even with insurance, many people wrote that they were unable to afford supplies. Esler wrote, “I attempted to get an insulin pump but found that even with the insurance I had, it was still thousands of dollars out of reach.”

Aside from health insurance, people with diabetes are much more likely to have economic problems. Studies show that people with diabetes are two and a half times more likely to be unemployed and to live in poverty than people without diabetes.

With diabetes, lack of money can seriously restrict people’s lives. Writing of one of her uninsured times, Esler recalled. “I re-used my syringes until they dulled and became painful… I hardly ever ate, rarely saw the doctor, and barely made ends meet.” One of her commenters wrote that his children had to do without, and they still don’t go out socially, even for “Saturday night out,” because they can’t afford it.

Cost issues can also interfere with doctors’ decisions. Dr. Anne Peters, director of the Clinical Diabetes Program at University of Southern California, says she modifies patients’ treatment based on what they can afford. “Many of the sulfonylurea agents are incredibly cheap and work,” she says, “but they do cause hypoglycemia and weight gain. Still, oftentimes, it’s all a patient can afford.” Other, less aware doctors may prescribe newer, brand name drugs that might be better, not realizing that their patients can’t afford them and will never fill their prescriptions. Many “can’t afford the copays that are required for some of the [newer] drugs,” says Peters

What Can We Do?
If medical costs are impoverishing you, I can think of a few options. Moving to Canada, where they have national health care, might be one. Finding a high-end job with good-quality insurance is another. Becoming poor enough for Medicaid or disabled enough or old enough for Medicare are others. Fighting for a single payer system or Medicare for all would be a long-term solution. But too many people wind up with option five: living a life of poverty and ill health.

The government does try to help a little. The National Diabetes Information Clearing House (NDIC) has a “financial help for diabetes page.” It starts by giving information on applying for Medicare, Medicaid, or SCHIP, the State Children’s Health Insurance Program.

When it comes to private insurance, NDIC says, “Many insurers consider diabetes that has already been diagnosed as a pre-existing condition, so finding coverage may be difficult.” But they go on to say that new laws are making it harder for insurers to exclude people. Here is some good information on buying private insurance from Georgetown University’s Health Policy Institute.

According to NDIC, leaving a job shouldn’t mean immediately losing insurance, because most workers are guaranteed 18 months of continuing coverage (COBRA). But it can be terribly expensive. The US Department of Labor has more info on COBRA here.

If you can’t afford market-rate health care, there are community clinics in many areas. Click on Health Resources and Services Administration or call them at (888) ASK–HRSA (275–4772).

Of course, paying for health care is only one way diabetes can make you poor. Sometimes it keeps employers from hiring you at all. Such discrimination is illegal, but it still happens. The American Diabetes Association can actually help you fight for your rights, sometimes.

And the reality is that, even without discrimination, a lifetime of diabetes can limit the amount and/or the type of work some people can do, because of fatigue, neuropathy, vision problems, or other issues.

I have a feeling our readers know much more on this subject than I do. What has been diabetes’ financial impact on you? How have you managed it? How could society change so this doesn’t happen so much?

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