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ACA challenge worries those with preexisting conditions

Diabetes patient Gabby Arias, 11, shows U.S. Sen. Tom Udall her insulin management system during his visit to her Rio Rancho home. Udall is concerned that conditions could become more complicated for Gabby and others like her if the Affordable Care Act is struck down or repealed. (Greg Sorber/Albuquerque Journal) 

Copyright © 2019 Albuquerque Journal

Gabby Arias is a typical preteen at Rio Rancho Middle School.

She likes looking at her phone and watching television, especially now that hot, summer weather is setting in.

She goes to dance class when school is in session. She swims.

But the 11 year-old also has some not-so-typical daily routines.

She has to monitor her blood sugar from almost the moment she wakes up in the morning to the moment she goes to sleep at night.

Gabby also has to monitor what she eats for every meal. She has to keep track of her carbs. She has lived with Type 1 diabetes for almost her entire life.

Gabby has succeeded in keeping her diabetes under control. But her mother worries that a legal challenge to the Affordable Care Act, which prohibits insurance companies from rejecting people with preexisting conditions, could be detrimental to her daughter’s health.

Oral arguments were heard last week on a challenge of the ACA by several Republican state attorneys general in the 5th U.S. Circuit Court of Appeals in New Orleans.

The AGs are arguing that the law is unconstitutional because the tax penalty for those without insurance has been removed. And they contend that the ACA has resulted in higher premiums.

Vanessa Arias, left, and her daughter, Gabby Arias, 11, discuss the costs of treating diabetes with U.S. Sen. Tom Udall during his visit to their Rio Rancho home earlier this month.

In a meeting with U.S. Sen. Tom Udall, D-NM, and representatives of the diabetes advocacy group JDRF earlier this month, Vanessa Arias voiced a concern about Gabby’s future after she moves out as an adult.

Udall said conditions could become more complicated for Gabby and others like her if the Affordable Care Act is struck down or repealed.

“We have a law on the books now, the Affordable Care Act, that says you can’t bar anyone with a preexisting condition,” Udall said. “That’s in a lawsuit now, and people are trying to repeal it. I think juvenile diabetes would be considered a preexisting condition. That’s a big issue.”

Udall said 133 million Americans have preexisting conditions.

The ACA was struck down by a federal judge in Texas but remains intact through the appeals process. The fate of the law could eventually rest with the U.S. Supreme Court, where it has already survived two challenges.

“At some point, Gabby’s going to leave my house,” Vanessa Arias said. “We won’t be able to supply her with insulin and her diabetic care. At some point, when she’s a 19-year-old, she’s on her own, how is she going to afford her insulin? How is she going to afford her test strips?”

Udall told Vanessa Arias she wouldn’t have to worry about Gabby losing insurance coverage if ACA remained intact since it allows children to remain covered by their parents’ plan until they’re 26.

Gabby’s routine has changed over the years. She’s gone from being a toddler running from her mother who was trying to give her insulin with a syringe, to administering a dose to herself through a pump in her arm.

“I’m more independent now that I’m older,” Gabby said.

She gives herself a dose of insulin when her blood sugar gets high. Gabby even gives herself a dose when she’s at school and under the watchful eye of a school nurse.

She was diagnosed when she was 16 months old, her mother said.

Gabby has been to the emergency room only twice in the past 10 years, including a trip to intensive care last year.

“If you can manage it more on the front end, it makes it so much easier on the back end,” her mom said. “Working with health care, I see all of the complications.”

Vanessa Arias works in radiology. She knows not taking care of diabetes could lead to leg amputations and kidney complications.

Vanessa said insurance coverage has been critical for Abby’s care from the moment she was diagnosed.

“In the beginning, I was working. My husband was staying home with our daughter,” she said. “I worked in health care in a hospital. My portion for health insurance at the time was $500 per month, but since then it has gone way higher. On top of having to pay for health insurance, we still had to pay for insulin, diabetes test strips … When she was newly diagnosed, we were at the doctor’s office every month doing follow-ups. We had to pay those co-pays.”

Her husband, Arnie, has since taken a job as a sheriff’s deputy. The Arias’ switched to his insurance because he had better benefits.

Currently, the family’s co-pay is about $800 every three months, including for supplies.

But they are not basic costs. Some negotiation with insurance companies is required. Vanessa Arias said she couldn’t imagine the costs if they didn’t have insurance.

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