Adequacy is also an issue with high-risk pool policies, Ms. Pollitz said. “High-risk pools often exclude preexisting conditions, so the thing that makes you eligible in the first place is excluded for 6-12 months.” Some pools also have limits on coverage for prescription drugs and mental health care.
On the private insurance side, the high-deductible policies that are increasing in popularity “really hit people with diabetes,” she said, noting that supplies for diabetes patients, such as medications, test strips, and insulin, can range from $350 to $800 per month, depending on whether the patient is experiencing complications. “Those costs really add up.”
The features of health insurance that hurt diabetes patients and others with chronic illnesses “were all adopted for reasons that were perfectly logical,” such as keeping insurance companies solvent, protecting insurers from adverse selection, or being able to offer cheaper premiums. “But those [features] tended to have been adopted one change at a time, so it was hard to step back and take a look at the big picture,” Ms. Pollitz said.
She added that the perspective of chronically ill patients “is a very important one to adopt when looking at proposals to change the health insurance system, because if change won't make it better for people who are sick, then what's the point?”