American Diabetes Association Expresses Deep Concerns with Affordable Care Act Repeal Legislation and Impact on Millions with Diabetes


Michelle Kirkwood

Arlington, Virginia
March 8, 2017

In response to the release of the recent legislation proposed to repeal and replace the Affordable Care Act (ACA), the American Diabetes Association (Association) sent a letter to Congressional leaders raising significant concerns on behalf of the nearly 116 million Americans living with and at risk for diabetes. The Association's Chief Scientific, Medical & Mission Officer William T. Cefalu, MD, released the following statement:

"On behalf of the nearly 30 million Americans living with diabetes and the 86 million more with prediabetes, the Association expresses our serious concerns with the American Health Care Act and the impact it will have for people with, and at risk for, diabetes.

Last December, the Association asked Congress not to repeal the ACA without replacing it simultaneously with an alternative plan that does not result in a loss of coverage or benefits for people with, and at risk for, diabetes. At minimum, any proposal to modify or replace the ACA must:

  • Provide coverage for at least the same number of people as under the ACA. No one should lose health insurance coverage as a result of the ACA repeal and replacement plan.
  • Ensure continuous availability of health insurance coverage regardless of a person's circumstances.
  • Ensure access to adequate and affordable health insurance coverage for everyone, regardless of health status, income, age, and employment.
  • Continue to prioritize prevention, including prevention of diabetes and its complications.

The Association is fully evaluating the impact this proposal will have on people with diabetes, and we look forward to seeing the Congressional Budget Office's (CBO) score, which will outline the effects this proposal will have on coverage and cost for all Americans. However, we have serious reservations about many of the proposals in this bill. Our areas of concern include the tax credit proposal, proposed changes to Medicaid, the continuous coverage premium penalty and cuts to funding for diabetes prevention programs.

The proposed tax credits in the American Health Care Act are significantly weaker than the current structure in the ACA, particularly for lower and middle income individuals. While the bill may lower premiums for some who are currently in good health, it will likely increase costs and provide less coverage for people with diabetes.

In addition, the changes proposed to Medicaid are particularly alarming and could have a drastically negative impact on low-income individuals and families affected by diabetes. Adults with diabetes are disproportionately covered by Medicaid. In Medicaid expansion states, more individuals are being screened for and diagnosed with diabetes than in the states that did not expand. Diagnosing the disease at an earlier stage and offering effective interventions is a key step in preventing or delaying the progression to complications of the disease. Thus, we oppose the proposal to repeal the Medicaid expansion created under the ACA. The Association also has deep concerns regarding the changes made to the financing structure of the Medicaid program through a per capita caps mechanism.

As stated in our principles above, any ACA replacement plan must ensure continuous availability of coverage regardless of a person's circumstances. Thus, the proposed continuous coverage premium penalty is of particular concern as it ignores the fact that some people experience a lapse in coverage because they simply cannot afford it, not because they choose to be uninsured. This is even more often the case for residents in states that did not expand eligibility to their Medicaid programs.

The Association is pleased to see that the bill retains the Essential Health Benefits standard for individual and small group plans. However, we are disappointed it removes them from Medicaid coverage.

Diabetes and its complications can be managed, and type 2 diabetes can often be prevented—if there is access to and availability of adequate and affordable health insurance. In the recent past, we have made great strides in improving the lives of those individuals with diabetes through innovative research, effective therapeutic interventions and improved access to care. If the ACA is repealed and not replaced by legislation that includes the aforementioned principles, there will be serious health implications for our most vulnerable population.

As always, we will continue to join forces with our fellow patient advocates and strategic partners to ensure access to quality care for those who need it, and we will continue to fight tirelessly to improve the lives of all people affected by diabetes."

About the American Diabetes Association

Nearly half of American adults have diabetes or prediabetes; more than 30 million adults and children have diabetes; and every 21 seconds, another individual is diagnosed with diabetes in the U.S. Founded in 1940, the American Diabetes Association (ADA) is the nation’s leading voluntary health organization whose mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. The ADA drives discovery by funding research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and works to safeguard policies and programs that protect people with diabetes. In addition, the ADA supports people living with diabetes, those at risk of developing diabetes, and the health care professionals who serve them through information and programs that can improve health outcomes and quality of life. For more information, please call the ADA at 1-800-DIABETES (1-800-342-2383) or visit Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn)