Moving Toward a Healthcare Bill: What People with Diabetes Need to Know


By: Pat Piper

The effort underway in Washington, D.C., to draft a healthcare bill is often described as “trying to get a handle on so many moving parts.” At issue is this: the House passed a 1,990 page bill in December followed by the Senate passing a 2,074 page bill on Christmas Eve. Now, those two versions are being merged into one with a conference committee that would be composed of House and Senate Members while, at the same time, the White House has been pushing for a deadline by the State of the Union Address, now scheduled for Wednesday, January 27.  So far, all sides believe there will be a health care bill in front of the president within the next few weeks. What it looks like is one of the “moving parts.”

Two Members of the Congressional Diabetic Caucus who have been involved in the negotiations to draft a healthcare measure spoke recently with Diabetes Health about what the country’s 24 million diabetics need from whatever bill reaches the president’s desk. Caucus co-chair Representative Michael Castle (R-Delaware) pointed to a pair of elements he wants to see in the final version: “There are two specific legislative priorities of the Diabetes Caucus that were included in the House bill, and I hope they are retained in any final agreement: H.R. 1625, to include services provided by podiatric physicians as reimbursable by Medicaid, which will help with effective disease management and preventing amputations; and H.R. 2425, to include Certified Diabetes Educators as designated providers under Diabetes Self-Management Education, as they most closely provide this essential training and education.”

Similarly, co-chair Representative Diana DeGette (D-Colorado) whose daughter has type 1 diabetes, has pushed for the public option, in which existing health insurance companies would compete against a government-run “company” as a way to control costs and keep premiums low. While the public option is part of the House bill, the Senate refused to include it—and this is one of the issues to be ironed out in the conference committee meetings between House and Senate Members. At this point, a national health exchange is being considered as a replacement for the public option. Under this concept, the uninsured, the self-employed, and small businesses can shop for healthcare plans that meet as yet unspecified standards. Another issue is whether a 40 percent tax should be imposed on “Cadillac Plans”—the expensive healthcare coverage with low deductibles that is available from numerous corporations and labor unions. It’s in the Senate bill, but not in the House version.

Republicans and Democrats are debating whether these meetings should be open to the public via CSPAN (so far the answer is “no”). They are also discussing whether the Democrats can just use their fragile majority to get a final version to the president without meeting with Republicans at all.

But, like Castle, DeGette wants a healthcare bill that provides opportunity for diabetics to understand the consequences of a bad diet. She points to the fact rhat according to the Centers for Disease Control and Prevention, one-third of the population is obese and that type 2 diabetes can be a result of excess weight: “A focus on prevention and wellness for type 2 diabetics is needed, as is making sure that we have full access to diabetes educators and the prevailing technology that is available in this country. It is important for diabetics to take care of themselves, and for type 2 obviously, in many cases, weight loss works, as does exercise and diet.”

In the early stages of the healthcare debate, a wellness initiative was discussed in Congress, in which efforts to improve one’s health, such as maintaining an A1c below 7% or keeping one’s weight in proportion to body type and height, were rewarded with a lower insurance premium. Neither DeGette nor Castle, however, supports going that far.

“I don’t think the best way to encourage a habit is to do it through lower insurance premiums,” DeGette said, “There has to be a better way to incentivize behavior, such as encouraging insurance plans to cover nutrition guidance, have access to educators, and all of that.” Still, it should be noted that wellness initiatives are already in use among college and university programs, some state programs, churches, labor unions, and businesses.

From the other side of the aisle, Castle is in agreement with DeGette’s approach. “While I have concerns that the healthcare reform bills may not achieve our goals of improving access to quality care and lowering costs for all Americans, I am pleased to see an increased focus on prevention and wellness and better access to routine medical care, which will positively impact the millions of Americans living with diabetes and other chronic conditions.”

Agreement has been fleeting when the topic becomes national healthcare in the United States. Consider this: In 1912, Theodore Roosevelt ran for president and lost. A major plank in his platform: national healthcare. Since then, the moving parts haven’t stopped moving. Stay tuned.

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Did You Know?
The Congressional Diabetes Caucus was formed in 1996 and has grown to be the largest caucus in Congress, with close to 250 members in the 111th Congress.



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