Advocacy

Ruby A. Neeson Diabetes Awareness Foundation, Inc.

Celebrating 12 Years of Community Outreach and Advocacy

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Ruby A. Neeson Diabetes Awareness Foundation is committed in proceeding with action on diabetes issues affecting the state of Georgia. Our intention is to help improve the prognosis and quality of health care for all persons affected by diabetes in the state.

According to the Georgia Department of Public Health more than 1 in 10 Georgia adults has diabetes, or more than a million people. Several hundred thousand more Georgians have pre-diabetes, a condition that can be prevented from becoming full diabetes through weight loss, increased physical activity, and better nutrition.

Important Facts about Diabetes in Georgia

- The prevalence of diabetes has increased by almost half since 2000 when an estimated

6.8% of adults had diabetes, compared to 9.7% in 2010.

- Approximately 6.5% of Georgians with diabetes have not been tested and are unaware

they have the disease.

- Georgia’s death rate for diabetes is 8% higher than the national average.

- Diabetes hospitalizations from Georgia’s Medicaid and State Health Benefit Plan

populations resulted in charges of $30 million in 20132

for just 36,567 admissions.

- As of 2013 the total cost of diabetes in Georgia is approximately $5.1 billion. Of that,

$3.3 billion was attributed to direct medical cost and the remaining $1.8 billion was

attributed to loss of productivity and sick days.

- Georgia currently has only 92 accredited self-management programs, an insufficient

number to meet the needs of the already nearly 1 million people with diabetes.

Our Priority Issues for Action

H.R. 5074, Kidney PATIENT Act of 2023: Bipartisan legislation, if passed would delay the implementation of adding oral-only end-stage renal disease (ESRD) phosphate lowering drugs to the Medicare ESRD payment bundle until January 1, 2033, or until an intravenous (IV) drug indicated for the reduction, management, or control of the serum phosphate has been approved by the Food and Drug Administration (FDA).

* Ruby A. Neeson Diabetes Awareness Foundation supports the Kidney PATIENT Act because approximately 1 in 3 adults with diabetes also have chronic kidney disease, one of the most common chronic conditions in older adults, a vulnerable population we primarily serve. In addition, chronic kidney disease (CKD) disproportionately affects the Black community – Black adults account for 35% of the people with kidney failure and 33% of those on dialysis in the U.S. but only comprise 13% of the population. Poorly managed CKD often leads to kidney failure, requiring individuals to undergo dialysis three times per week to stay alive. About 80% of kidney patients receive phosphate-lowering drugs to help manage their kidney disease. We understand that the Centers for Medicare & Medicaid Services plans to move oral-only phosphate lowering drugs into the ESRA bundle beginning January 2025. We are familiar with this issue because of the many people that we support undergo vital dialysis treatment. Most of the dialysis patients that we serve at RANDAF must take phosphate lowering drugs. They take these drugs with snacks and meals at home; in fact, food is what makes these drugs work. Moving these drugs into the ESRD bundle will mean that these drugs will now be dispensed at the dialysis center rather than the pharmacy. However, patients aren't allowed to eat when they receive dialysis. Additionally, demanding these drugs be dispensed at the dialysis center puts additional stress on already vulnerable patients by requiring them to go to the dialysis center even more frequently (4+ times a week now) to receive their needed medication. Changes to patient care should make sense and make things easier for patients rather than create unnecessary barriers. We are immensely concerned that these changes will result in worse health outcomes for ESRD patients. The Kidney PATIENT Act will maintain the status quo and delay the implementation of adding oral-only ESRD phosphate-lowering drugs to the Medicare ESRD payment bundle until 2033 or until new intravenous therapies come to the market, ensuring that patients can access the drugs prescribed by their physician at an affordable rate without hindering further innovation.

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The Affordable Insulin Now Act: Introduced by Senator Reverend Raphael Warnock, this legislation would cap out-of-pocket costs of insulin products at $35 per month for people with private health plans and Medicare Part D plans, including Medicare Advantage drug plans. For commercial plans this applies to one of each dosage form (ie. vial, pump, inhaler) of each different type of insulin (rapidacting, short-acting, intermediate-acting, long-acting, ultra long-acting, and premixed). For Medicare plans, this applies to all covered insulin products and copays are capped at $35 for all preferred and nonpreferred products included on plan formularies. This would begin October 1, 2022 for Medicare plans and January 1, 2023 for private health plans.

* Ruby A. Neeson Diabetes Awareness Foundation believes that the inflated cost of insulin has become an urgent public health concern. Insulin therapy is vital for people with Type 1 diabetes and for many patients with Type 2 diabetes. There have been many recent reports of deaths in diabetic patients because of the lack of affordable insulin. This has caused many diabetics to ration the amount of insulin they use, which can lead to life-threatening implications, including premature death. Additionally, this may provoke diabetes conditions to worsen, causing a "domino effect" that can burden society and families with added stress and financial hardship. Although, we are mindful this mandate does not address the uninsured population, we however recognize separate Medicaid expansion efforts.

Pharmacy Benefit Managers (PBMs) Abuses: Pharmacy Benefit Managers (PBMs) are the middlemen that come between a patient and their doctors, causing unnecessary suffering by delaying, denying, or obstructing care altogether. Because of PBMs, patients specifically with diabetes, often dependent on insulin therapy, and other serious diseases often pay more for vital treatment and do not get the care they need.

* Ruby A. Neeson Diabetes Awareness Foundation supports the summary outlined here by U.S. Representative Buddy Carter, representative for Georgia's 1st congressional district. Additional information can be found on this attached handout.

Easy Enrollment in Health Care Act: The Easy Enrollment in Health Care Act is legislation to simplify health care enrollment. The bill will streamline health care enrollment for uninsured families and help close the massive gap in eligible but uninsured Americans. This legislation, modeled off a program already successfully in place in Maryland, would provide Americans the opportunity to receive health care plan information and enroll through their federal income tax returns.

* Ruby A. Neeson Diabetes Awareness Foundation believes Georgian who may qualify for free or low-cost health insurance coverage unfortunately are not already receiving it because they are not enrolled in accessible plans for which they are eligible. The time is now to close the gap and get more people covered by enrolling in plans they qualify for.

Healthcare Workforce Resilience Act: The Healthcare Workforce Resilience Act is targeted and timely bipartisan legislation that will strengthen the healthcare workforce and improve healthcare access for Americans. One-sixth of our healthcare workforce is foreign-born. Immigrant nurses and doctors play a vital role in our healthcare system, especially in medically-underserved areas of our country. This includes communities in Georgia, where there is a high prevalence of diabetes.

* Ruby A. Neeson Diabetes Awareness Foundation believes because Georgia is a culturally diverse state, with many at risk or already living with chronic-disease, qualified foreign-borm healthcare workers have a unique ability to render culturally sensitive care, and timely healthcare which will overall contribute to better health outcomes in vulnerable populations. Learn more here.

Congressional Diabetes Caucus: The Congressional Diabetes Caucus has an essential role in helping to constitute legislation, (laws and rules made by the government) to provide Medicare coverage for diabetes self-management education, vital diabetes supplies including blood testing strips, and glucose monitors. The Congressional Diabetes Caucus successfully implored the Centers for Medicare and Medicaid Services to provide coverage for insulin infusion pumps. The Congressional Diabetes Caucuses is in both the US House of Representatives and Senate; and is the largest health caucus in Congress.

* Ruby A. Neeson Diabetes Awareness Foundation believes that the entire Georgia Congressional delegation should be a part of the Congressional Diabetes Caucuses. We are taking action with other community members by vigorously reaching out to representatives to ask them to be a part of The Congressional Diabetes Caucus by joining if they are not a member. If your representative is a member we encourage you to periodically thank them. Members can be found here.

Expanding Access to Diabetes Self-Management Training (DSMT) Act (H.R. 1840, S. 814): Diabetic Self-Management Training (DSMT) Accreditation Program. National Partnership to Improve Dementia Care in Nursing Homes. The H.R. 1840, S. 814 bill expands Medicare coverage of diabetes outpatient self-management training and establishes a demonstration program to test an online platform that provides such training.

* Ruby A. Neeson Diabetes Awareness Foundation believes expanding access to this benefit can help improve people with diabetes quality of life, as well as emerge in better Medicare cost savings.

National Housing Trust Fund: The National Housing Trust Fund (HTF) is focused on the building, rehabilitating, preserving, and operating rental housing for extremely low-income people. According to the National Low Income Housing Coalition, across Georgia, there is a shortage of rental homes affordable and available to extremely low income households, whose incomes are at or below the poverty guideline or 30% of their area median income. Many of these households are severely cost burdened, spending more than half of their income on housing.

* Ruby A. Neeson Diabetes Awareness Foundation believes it is important to undertake the issue of housing disparities by confronting the sky-rocketing distress of unsuitability in housing as unstable housing can amplify an increased risk of diabetes-related emergencies, and poor mental health concerns. Access to supportive housing is important for vulnerable individuals with diabetes. We support efforts that urge congress to protect and expand the HTF.

All advocacy is, at its core, an exercise in empathy.