Scariest thing in the world

Wes Craven has certainly tried hard over the years to give us scary. Joss Whedon sprinkled it with humor. Edgar Allen Poe taught us all some lessons in horror.

Then there is real scary. The kind you don't find in books or movies. The slow fear that doesn't have a release in a moment involving some guy in a mask.

For two years, I was a diabetic without health insurance. Doesn't sound like the kind of thing John Carpenter would toss out there for 90 minutes, does it? But it is, without a doubt, the scariest thing on Earth.

I was laid off in 2008, one week precisely before Lehman Brothers crumbled and the global economy with it. While I was offered COBRA and searched desperately for some way to keep my insurance, there was nothing I could qualify for as a diabetic for less than $700 a month. Unemployment insurance only added up to about $1400 a month, so to pay for insurance, I'd have to skip rent or utilities or food.

Medicaid was no help either. Illinois is a great state, but our Medicaid system here is currently set up to help only the lowest of the low. I "made too much money" on unemployment, even as a diabetic, to qualify for the program.

Yet without insurance, insulin, the very thing I need to take multiple times a day just to live, would cost me insane amounts of money. I take two types of insulin. Each bottle of insulin lasts me about two to three weeks. Each bottle without insurance costs over $110-120. It would cost me over $450 a month just for my insulin. That doesn't begin to take into account the syringes, the other pills I take to help control aspects of my health as a diabetic, or any of the other conditions that I have related to my diabetes or not.

Taking care of my health looked impossible. I was lucky though. I had some amazing doctors and nurses that did everything they could to get me insulin, that helped me navigate the systems to eventually get set up for charity care where we could, and even cajoled a few pharmacy reps I think into making sure I survived. I would not be here but for their incredible hard work and help.

Despite all that hard work, it was still not always enough. I had to pay out of pocket once, early on when I still had a small emergency reserve of money, and visit the emergency room three times to get insulin when we couldn't get it fast enough from our various alternate sources. That's three ER visits that the state had to pay for, and therefore, in the end, you footed the bill through your tax dollars in the most inefficient way possible.

The Affordable Care Act changed all of that. I was one of the first to sign up for the "high-risk pool", IPXP here in Illinois, that was set up to help get those of us with pre-existing conditions in the individual market into plans that could help us until the health insurance exchanges start in 2014. I stood side-by-side with Governor Quinn as he announced the program to the public, and I defend it to this day as an important stop-gap measure.

Thanks to the subsidies made available through Obamacare, IPXP only costs me about $150 a month instead of the $700 I was quoted before. It'll be more now that I've celebrated my 35th birthday, going up to $200 a month, but that's still far better than not having insurance at all.

I got a job after three years of looking, one year after I got into the IPXP plan, but it was a contractor position that didn't offer benefits. I kept the IPXP plan through that year of employment, and I didn't have to worry about trying to wait until a job came along that offered health benefits. Now that I'm once again in the job market, I seamlessly have nothing to worry about from IPXP as it stays with me. This is what everyone can look forward to with the exchanges starting in January 2014.

One of the last fears I had left was washed away when the Supreme Court declared the ACA constitutional and upheld the law. (See my reaction to the ruling here) It's not the last hurdle, but it is one of the most important ones. There is no doubt now that Obamacare is the rightful law of the land and can help 32 million previously uninsured Americans just like me to ensure that health care is a right, not a privilege.

There are still challenges, and I hope you'll stand with me to ensure that I, and so many more just like me, never face that fear again. We will talk about many of those challenges in the days ahead, no doubt. Thank you for being interested in my story and for doing your part to ensure health care for all.

David Zoltan,
Guest Blogger for Illinois Health Matters

The Affordable Care Act: Preventing Chronic Diseases

Did you know that switching the focus from treating chronic illnesses to preventing the diseases will not only improve the health of individuals and families all over the country, but will also rein in health care costs and strengthen the economy?

The Affordable Care Act (ACA) is applying this logic in its fight to lower the rate of preventable chronic illnesses, produce real savings in the health care sector, and recover lost economic activity at the local, state, and national levels. And it’s doing it in the name of prevention through effective public health initiatives.

The prevalence of chronic health conditions in the United States is taking a huge toll on our citizens, our nation’s health care spending, and our workforce. More than half of the people living in the United States have at least one chronic health condition, such as heart disease, stroke, diabetes, obesity, and cancer. Chronic health conditions account for 7 out of 10 deaths in Americaand rack up 75% of our nation’s health care spending. The cost for treating people with type 2 diabetes, heart disease, hypertension, and stroke, alone, amounts to $238 billion each year. In 2010, the United States spent almost $2.6 trillion on health care, meaning we spent around $1.9 trillion just last year on treating and managing chronic illnesses, most of which are largely preventable. Here in Illinois, more than 6.7 million people have reported being diagnosed with a chronic health condition, costing the state $12.5 billion in annual health care expenses.

What’s more is that the cost of chronic health conditions goes beyond the money spent on health care services. The toll these illnesses take on our workforce productivity is telling. According to the Gallup Poll, 7 out of 8, or 83 percent of American workers either have a chronic health condition or are obese. The poll estimates that this prevalence of chronic illness and obesity in our workers could be costing our economy $153 billion a year in lost productivity due to increased sick days. Other reports that take into account other chronic conditions and factors like lost productivity from workers who show up on the job while sick estimate that chronic health conditions are costing the United States more than $1 trillion each year in lost economic activity. To bring these statistics home, chronic disease plaguing Illinois’s workforce cost the state $14.3 billion in lost productivity. And the commonality of chronic disease is rapidly increasing. It is estimated that the number of Americans living with a chronic health condition will increase by 36%, or 46 million people by the year 2030, and that we could be spending $685 billion a year on medical treatment for chronic disease by 2020. Other sources estimate the total economic toll of chronic health conditions to reach $6 trillion a year by the middle of the century.

But it doesn’t have to be this way. As the CDC states, “Access to high-quality and affordable prevention measures (including screening and appropriate follow-up) are essential steps in saving lives, reducing disability and lowering costs for medical care.” And research has proven that for every dollar invested in effective prevention and public health initiatives, $5.60 is saved. The same study reveals that, if we invest $10 per person every year in effective community-based public health programs, we could save the United States more than $16 billion in just five years. 

Fortunately, the Affordable Care Act recognizes the benefits to be had from investing in smart and effective preventive and public health efforts. The ACA established the National Prevention, Health Promotion and Public Health Council within the Department of Health and Human Services (HHS), made up of secretaries from various federal departments and chaired by the Surgeon General. The Council is responsible for developing our first ever National Prevention and Health Promotion Strategy, which was released in June of 2011 and identifies four strategic directions for preventing disease and improving health nationwide. The four strategic directions are: creating healthy and safe community environments; expanding access to quality clinical and community preventive health service; empowering people to make healthy choices; and eliminating health disparities. The Council is charged with providing leadership moving forward with the National Prevention and Health Promotion Strategy.

The ACA also established a Prevention and Public Health Fund, which is administered by the Secretary of HHS, Kathleen Sebelius, and provides financial support for state and community-wide efforts to prevent disease and promote healthy lifestyles. The Fund is a 10-year, $15 billion commitment to support prevention and public health programs across the country, like theCommunity Transformation Grants, which fund community-level programs geared towards reducing the prevalence of chronic disease and promoting healthy lifestyles.   Already, $103 million in grant money has been issued to 61 different state and community programs across the country, reaching 120 million people.

So what does all of this mean for chronic disease in Illinois? Already, the State of Illinois has received $17.14 million out of the Prevention and Public Health Fund to support community- and state-level wellness and prevention programs aimed at preventing chronic disease and raising awareness about healthy living. For a breakdown of what programs received funding and for how much, visit HealthCare.gov online.

The Secretary of HHS will continue to issue funds for prevention and public health programs across the country to reverse the trend of chronic disease, so stay tuned as health reform continues to make a positive impact in our communities. To find out what other kinds of initiatives the Affordable Care Act has taken to increase access to preventive health measures and decrease illness in America, visit the Shriver Brief online.

This post was originally posted on The Shriver Brief by Caitlin Padula. It is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Medicaid Cuts Could Leave Hundreds of Thousands of Illinoisans Facing Life-Threatening Health Challenges

Report Details Number of Illinoisans with Cancer, Heart Disease, Stroke, Diabetes, and Chronic Lung Disease Who Depend on Medicaid for Treatment

Cuts to Medicaid would pose a specific and dangerous threat to hundreds of thousands of Illinoisans who depend on the program for regular treatment for such medical conditions as cancer, diabetes, chronic lung disease, heart disease, and stroke. Without Medicaid, many of these seriously ill Illinoisans would no longer be able to fill essential prescriptions, keep up with key screenings, or see a doctor if their condition worsens or recurs.

The importance of Medicaid to Illinoisans is detailed in a report released jointly today by the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Lung Association, and the health care consumer group Families USA.

Hundreds of thousands of Illinoisans are covered by Medicaid. Of this number:

• An estimated 23,760 Illinoisans with Medicaid have cancer, including 1,000 children, 15,780 adults, and 6,980 seniors;
• An estimated 97,170 Illinoisans with Medicaid have diabetes, including 7,360 children, 64,490 adults, and 25,320 seniors;
• An estimated 263,750 Illinoisans with Medicaid have chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis, including 146,650 children, 100,610 adults, and 16,480 seniors; 
• An estimated 243,990 Illinoisans with Medicaid have heart disease or stroke, including 23,540 children, 164,600 adults, and 55,850 seniors.

Although Illinois directly administers its own Medicaid program, every dollar the state spends for health coverage for low-income individuals is matched dollar-for-dollar by the federal government. Particularly during difficult economic times, this federal match helps Illinois to provide health coverage for hundreds of thousands of residents.

The treatment of chronic and life-threatening diseases can be extremely costly, and people with these illnesses often become eligible for Medicaid when they have exhausted all their financial resources paying for medical care. As an example, the average hospital charge nationally for a stay associated with a heart attack is nearly $63,000, and for people with no health insurance or with inadequate coverage, such costs can quickly drive them into poverty and qualification for Medicaid.

“Hard-working Americans with diseases such as cancer can get health coverage through Medicaid after having lost their health insurance because they are too ill to work or run through their savings,” said Christopher Hansen, President of the American Cancer Society Cancer Action Network. “This program is a safety net for American families, and losing access to the program could force them to stop treatment that could save their lives.”

“Diabetes has a disproportionate impact on the Medicaid population, because Medicaid provides important health coverage to people facing elevated health risks. Children and adults eligible for this valuable program are more likely to be in poor health and thus require the services Medicaid provides to a greater extent than individuals with private insurance,” said Gina Gavlak, RN, BSN, Vice Chair of the National Advocacy Committee, American Diabetes Association. “Cuts to Medicaid funding would be harmful to the millions of children, pregnant women, and adults with diabetes who rely on the program to manage their disease and avoid dangerous and costly diabetes complications such as blindness, amputations, and kidney dialysis.”

“Medicaid is the lifeline for millions of children, adults, and seniors who suffer from chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis,” said Paul Billings, Vice President of National Policy and Advocacy for the American Lung Association. “If denied this critical healthcare coverage, it will result in higher healthcare costs, such as increased emergency room visits. We need to set politics aside and protect the health of our nation’s most vulnerable population, particularly our children, who will be most impacted by cuts to Medicaid.”

“Medicaid is a program that works and a program that provides urgently needed care to hundreds of thousands of people in Illinois suffering from serious but controllable diseases. It helps Illinois children get a healthier start in life and school, it helps to maintain a healthy Illinois workforce, and it helps head off medical debt, a leading cause of bankruptcies and home foreclosures,” Ron Pollack, Executive Director of Families USA, said today. “It should be crystal clear that with rising health care costs hurting family pocketbooks and with the economic downturn driving more families to depend on Medicaid, that this is precisely the wrong time to cut Medicaid funding to Illinois and other states.”

Families USA contracted with The Lewin Group to develop the estimates in this report.

Dave Lemmon, Families USA, 202-628-3030
Alissa Havens, Anerican Cancer Society Cancer Action Network
Christine Fehely, American Diabetes Association
Mary Havell, American Lung Association