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President Obama’s signature legislation, the Affordable Care Act (ACA), has touched the lives of nearly every American. Over 20 million people are currently covered by a healthcare plan governed and facilitated by the Health Insurance Marketplaces (healthcare.gov), established by the ACA. While many discussions focus on the Marketplace and ACA in general, an important discussion needs to happen about Medicaid.Medicaid expansion has opened up the opportunity for many people who didn’t qualify for Medicaid traditionally thanks to its income-only requirement. For people in the 32 states who have adopted the expansion, if their income is at or below 138 percent of the Federal Poverty Level (FPL), they can qualify for Medicaid.For all of its controversy, the facts remain clear: the ACA has helped millions of people afford healthcare coverage, access contraceptives, receive mammograms and other important health screenings, and provide healthcare to their children up to the age of 26. For people with diabetes, we cannot be charged more for coverage than those without diabetes and we cannot be denied.However, if the current Republican leadership gets its way, that’s all about to change. President Trump, Vice President Pence, and a sizeable number of Republican lawmakers in Congress have already begun to pave the way for a swift repeal of the ACA. What’s even more concerning to a large number of Americans is that they have no solid plan prepared to replace the ACA in the event of its repeal. (While they have proposed plans and two are in the markup phase, many experts have come forward to state that these are not solid or sustainable.)The initial plan is to repeal large portions of the ACA, including the Medicaid expansion, but the long game is to repeal virtually every provision of Obamacare, except for allowing children up to 26 years of age to stay on their parents’ plans - and at first glance, protect those with pre-existing conditions.To understand the impact this repeal would have on patients with diabetes, it’s necessary to first explain what Medicaid used to look like and how the expansion changed it.

Medicaid Prior to 2013 and How the ACA Changed It

Before President Obama initiated the Medicaid expansion provision of the ACA, the population of those enrolled in Medicaid tended to fall into five major groups: low-income children, pregnant women, the elderly, the disabled, and some parents.Many individuals with serious health complications, such as diabetes, weren’t sick enough to warrant a disability status, and some couldn’t find health coverage at all due to their having a pre-existing condition. The Medicaid expansion changed all of that, making it so that income alone could qualify a person as entitled to Medicaid benefits.In other words, instead of having to prove a litany of factors ranging from family status and household size to disability and other characteristics, interested individuals could qualify for Medicaid on the sole condition that their income was less than 138 percent of the Federal Poverty Level.By creating this expansion, Obama allowed nearly 17 million people who were either paying astronomical fees for healthcare or couldn’t obtain it at all to enroll in Medicaid and receive healthcare coverage, some for the first time in their adult lives.

What Would the ACA Repeal Look Like?

In a January 2017 article, Democracy Now quoted former Press Secretary Josh Earnest’s summary of what an ACA repeal would look like.

“Twenty-two million people are going to lose their health insurance if the Affordable Care Act is repealed. It’s going to rip a hole in the deficit, in the federal budget, and the deficit will go up, if the Affordable Care Act is repealed. That’s not just my conclusion; you can ask the CBO about that.”

How is that possible? If Republicans repeal the ACA they will effectively cauterize the flow of billions of dollars of subsidies currently supporting the 32 states that have expanded Medicaid, as well as some private health insurance coverage through the exchanges.All of the funding that made it possible for 22 million people to obtain health care coverage, including the 17 million who have access to Medicaid only because of that funding, will disappear overnight, leaving nearly all of those currently covered under the ACA either without coverage or trapped in a chaotic transition that could make health care difficult if not impossible to obtain.With no clear plan to replace the ACA, only a swift series of actions intended to repeal it, there’s no telling how disastrous it could be.DPAC makes it easy to send a message to your Congressional represenatives. With a few clicks, you're on your way. Click now...

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Stakes Are High for Diabetes Patients on Medicaid

All of that information is startling enough, but when the ramifications of an ACA repeal are applied to specific situations, such as the millions of diabetic patients currently covered by ACA provisions, the picture becomes even scarier. Diabetes patients rely on medication and strict physician oversight in order to maintain their health. Without insulin, prescription medication, and regular doctor’s visits, one episode of high or low blood sugar could be deadly. For those utilizing Medicaid, losing coverage is a recipe for disaster.However, there might be some good news amid all the fear and speculation.

How Likely is an Overnight Repeal

The situation above is the worst fear of millions of Americans with diabetes, and given how high on the agenda an ACA repeal is, the widespread fear over what might happen is understandable. However, there is a silver lining.As an Insulin Nation article aptly pointed out, the situation isn’t quite as dire as it seems. While the repeal of the ACA would be hard on everyone, such a repeal would take quite some time to go into effect, and along the way its implementation would cause sweeping economic problems and likely be challenged by innumerable court cases.That’s assuming the repeal gets passed in the first place. Republicans did not obtain the supermajority they needed in order to pass an ACA repeal uncontested. There are enough options for congressional Democrats to confront and potentially stop a repeal, especially given the fact that if every member of Congress voted along party lines, Republicans wouldn’t be able to obtain the 60 necessary votes to end a Democratic filibuster.While it's likely that the wheels of bureaucracy would stall the implementation of an ACA repeal, perhaps for years, the possibility that it could be repealed at all still remains a source of concern for many, and rightly so.

How Can Our Diabetes Community Help?

Mobilization and activism are crucial in this tense political climate, and using your voice to let the government know how an ACA repeal would affect you is your duty and right.You can make your voice heard right now by sending a message to Congress, asking them to protect those with diabetes. If we don't tell them that people with diabetes matter, who will? Our community must unite - and whether you use Medicaid, Medicare, employer-based, or individual insurance coverage, this repeal will impact all of us.DPAC makes it easy to send a message to your Congressional represenatives. With a few clicks, you're on your way. Click now...