Healthcare Reform Principles for the 111th Congress

Diabetes places a tremendous burden on the nation'seconomy and the quality of life for individuals with the disease. According to the Centers for Disease Control,an estimated 24 million children and adults in the U.S. live with diabetes.[1] Diabetes expenditures account for $174 billion per year in direct medical costsand indirect costs such as disability, work loss, and premature mortality.[2] Nearly one-third of every Medicare dollar isspent on people with diabetes.[3]

The Diabetes Control and Complications Trial conducted by the National Institutes of Health showed that keeping blood glucose levels as close tonormal as possible slows the onset and progression of costly complications suchas eye, kidney and nerve damage caused by diabetes.[4] The Federal government andJDRF recognize this and are making dramatic strides in diabetes research, whichis improving the lives of those with diabetes by preventing or delaying theonset of the disease and complications, as well as moving us closer to our goalof a cure. However, until there is a cure, bettermanagement of diabetes is needed to complement the research effort and mitigatethe escalating costs and burden on individuals with diabetes and the nation'seconomy. As part of overall health carere form, JDRF strongly supports and will advocate for the following principles that will help children and adults living with type 1 diabetes:

1. Adequate & Affordable Health Insurance Coverage without Pre-existing Condition Exclusionsor Penalties

Health insurance coverageis a critical issue for people of all ages who have type 1 diabetes. Those with private coverage face the constantthreat of being dropped from their carrier or not being able to afford theircoverage due to their type 1 diabetes diagnosis. In coverage transitions -- such as youngadults aging off of their parents' policy, people with a break of 63 days ormore in coverage, and individuals moving out of Medicaid or State Children'sHealth Insurance Program eligibility -- insurance companies may not coverpre-existing conditions or may restrict their coverage. In addition, health insurance under COBRA mayor may not be available for individuals who lose their job and COBRA may becost prohibitive for many people in this situation. To help bridge the gap, peoplewith type 1 diabetes must be able to obtain adequate and affordable healthinsurance.

2. Access to Treatment & Technology

Clinicalresearch shows that even vigilant patients who check their blood glucosefrequently spent less than 30 percent of the day in the normal glucose range.[5] Improved access to treatments and technologies tobetter control blood glucose may cost more initially, but with widespreadadoption will over time reduce the risk of diabetes complications and therelated burden on our health care system. At the same time, a regulatory system that continues to protect patientswithout stifling the development of life saving technologies is essential tothe success of managing diabetes and its costs in the future.

3. Adoption of Health Information Technology withPatient Privacy Protections

Humanclinical trials are the final phase of research before a new drug or treatmentis approved for the market. The adoptionof health information technologies can help advance human clinical trials byautomating the collection of clinical data and facilitating the reporting ofnew incidences of type 1 diabetes. Inaddition, adoption of health information technologies will improve the qualityand coordination of patient care, but it must be done with clear protections toensure that patient privacy is maintained.

4. Appropriate Education and Payment forEndocrinologists & Diabetes Care Providers

Thehealthcare workforce is facing a severe shortage of endocrinologists and otherdiabetes care providers as the incidence of diabetes and the therapeuticoptions are growing rapidly. Inthe current system, the comprehensive diabetes care provided for patients on intensiveinsulin therapy is reimbursed at a level of a routine office visit. However, such care involves evaluations whichfar exceed the routine office visit, such as intensive self-managementtraining, continuous glucose monitorteaching and downloads, individual phone or email consultations, and otherservices. As expected, the disincentiveswhich currently exist have created a shortage of diabetes care specialists,which is only expected to increase in the future. Adequate reimbursement for services providedand funding for professional education, residencies, and fellowships are neededto encourage students to enter the field of diabetes care.

[1] Centers for DiseaseControl. Number of People with DiabetesIncreases to 24 Million. CDC, June 24, 2008.

[2] T. Dall, S. Mann, Y. Zhang,J. Martin, J. Chen, P. Hogan. EconomicCosts of Diabetes in the U.S.in 2007. Lewin Group Inc. 2008.

[3] Center for Medicare and Medicaid Services" http://www.cms.hhs.gov/CCIP/.

[4] http://diabetes.niddk.nih.gov/dm/pubs/control/

[5] BodeBW, Schwartz S, Stubbs H, et. al., 2005. Glycemic Characteristics inContinuously Monitored Patients With Type 1 & Type 2 Diabetes, DiabetesCare 28: 2361-66.

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