Inability to Afford Health Insurance with Type 1 Diabetes 1

The Inability to Afford Health Insurance While Diagnosed with Type 1 Diabetes

Carsen Swallen

University of Alabama
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 2

Shannon’s Story

To gain better insight into someone who is living with type 1 diabetes the researcher

interviewed a woman and we will name her Shannon. Shannon is a 23-year-old who recently had

to move off of her parent’s health insurance due to their retirement. Shannon works part-time and

her employer does not offer health insurance benefits to those who do not work full time.

Shannon is hoping a full-time position will open up, but in the meantime, she finds herself

without insurance while having a life-threatening disease that requires daily monitoring and

management. Shannon has been living with type 1 diabetes for a little over twelve years but has

never been without health insurance until this most recent event. This massive change in

Shannon’s life as forced her into the health disparity of the inability to pay for her care and

treatment.

Interview

The first question the researcher asked Shannon was, “What are a few things you struggle

with daily because of being uninsured with type 1 diabetes?” Shannon started the conversation

by saying she struggles with many things. One of the main things she struggles with is the added

expense for her chronic condition. “Since I live alone there is not only food and shelter that I

need to worry about, but also how I am going to afford my next vial of insulin or test strips that

are needed daily?” Shannon also then added that sometimes she goes without proper nutrition to

ensure that she can afford the medications she needs. Bouncing off of these statements the

researcher then asked, “What is the average cost of your type 1 diabetes medications and how

often do you need to purchase your medicine?” Shannon was very quick to state that she pays a

lot more than she ever thought was possible for her medications. To start off Shannon needs three

vials of insulin per month. Each vial costs her around $300. For one single year Shannon will
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 3

spend $10,800 for just insulin. She then moved into the cost of her test strips. She stated,

“Around 50 strips cost about $30 and I average six strips a day. This means I spend around

$1,380 for these test strips yearly.” Shannon also mentioned that for her blood sugar monitor and

her insulin pump they both cost a total of around $3,500 for a three-month supply. In total,

Shannon’s medications and supplies cost around $15,680 per year. With the cost of type 1

diabetes without health insurance understood, the researcher then asked, “When it comes to

being uninsured with type 1 diabetes, do you think it has affected you not only physically but

mentally as well?” Shannon’s response was, “It has definitely impacted me mentally and

physically. From disordered eating and terrible relationships with food to the mental drain that

comes with trying to pay for my medications. On the physical side, I recently had an infection in

my toe that had to be drained due to my diabetes.” Shannon having to spend money for that

doctor visit made it extremely hard for her to afford the medicine she needed for the rest of the

month. The researcher then moved on to the next question which was, “What are some of your

worries being uninsured with type 1 diabetes?” Shannon explained that her most constant

concern is, “How am I going to afford this?”. She also said that on a larger scale she is concerned

with the other health issues that come with type 1 diabetes that can affect her at any point. “If I

do become affected by other health issues, I would have no means to pay to get treated.” This led

into the next question the researcher asked, “How do you cope with being uninsured while

having a chronic disease?” Shannon said, “I don’t really think I cope in any specific way. I

manage it, that’s the best way to describe it. I don’t really see it in any other way than a part of

me now. It’s just another thing that I have to consider when budgeting money.” Budgeting money

for medication needed for survival can become very stressful for anyone. The very last question

the interviewer asked was, “Since you are living with type 1 diabetes uninsured, what are some
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 4

recommendations you would give to others who are in the same shoes as you?” Shannon

emphasized that no one should try to go without their insulin or try to ration what they have as it

could be deadly. Shannon also suggested that people should speak to a healthcare professional

about finding low cost suppliers or programs that may offer discounted meds to those who

qualify. She said, “Sometimes you have to think outside of the box in order to survive”.

Conclusion

The information that was provided by Shannon gave great insight into what it is like for

someone to be living with type 1 diabetes while being uninsured. It is clear that this health

disparity can be impactful on someone’s personal life. “Thinking outside of the box to survive” is

something she and others have to do daily to afford their medications. This statement is very eye

opening as most individuals don’t have to think this way. It is evident that there needs to be

solutions to this ever-growing problem in the United States.

INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 5

Abstract

The United States is currently facing a significant health disparity between the inability to

afford health insurance and having type 1 diabetes. It is well understood that these individuals

have been put at a disadvantage due to the cost of care and treatment. This perspective paper

aims to determine what the problems and possible solutions are for those who are uninsured with

type 1 diabetes. Specifically, it investigates how these solutions would be beneficial to uninsured

type 1 diabetic patients. Data was used from a variety of sources including Predictors of direct

costs of diabetes care, to determine the cost difference from insured to uninsured Americans

living with type 1 diabetes. The results suggest that those who don’t have health insurance

combined with type 1 diabetes are at a disadvantage to receive the treatment and lifesaving drug

needed for survival. The findings also indicate that there are possible solutions to allow these

individuals to live a better quality of life with type 1 diabetes.

Keywords: Uninsured Americans with type 1 diabetes, solutions for inability to afford

treatment, healthcare, insulin, medication.

INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 6

Health disparities

Health disparities have become an increasing issue within many populations. One in

particular is the inability to afford health care. This inability tied along with having type 1

diabetes is the reality for many. These individual’s socioeconomic status governs whether the

lifesaving medicine needed for their survival can be obtained. Medications and equipment used

by those diagnosed with type 1 diabetes can be an exorbitant cost without health insurance.

Without health insurance these individuals are put at a disadvantage to receive the treatment

necessary to live a good quality of life. With every obstacle there are solutions that can address

this growing health disparity among individuals in the United States.

Medications

To address the health disparity of inability to pay for healthcare with type 1 diabetes we

must first understand the issue at hand. For starters, “Predictors of Direct Costs of Diabetes Care

in Pediatric Patients with Type 1 Diabetes” states, the total diabetes-related direct costs per

person a year averaged $4730 (Ying,et al., 2011). Looking at Table 1, of that expense 33% of

that total went to Medications which is equivalent to around $1564 yearly (Ying,et al., 2011).

These numbers were determined based off of insulin dosage and type of insulin regimen

prescribed for their health needs. These are the prices that are put forth by millions of people

yearly who are diagnosed with type 1 diabetes. The issue with the numbers stated above however

are calculated for those who have health insurance. This begs the question of how much do those

without health insurance have to pay. As we have learned from the interviewee Shannon its

considerably more. When viewing Figure 1, we notice that Shannon pays thousands of dollars

more than her counterparts who have health insurance. Type 1 diabetes is an expensive chronic

illness and just the medication costs can be unfeasible for many. Shannon also stated that it is
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 7

more beneficial for her to save the money she has for her medicine then it would be to splurge on

health insurance to lower the cost. According to “Socioeconomic position is associated with

glycemic control in youth and young adults with type 1 diabetes,” the socioeconomic positions

of these individuals also impact their ability to achieve optimal glycemic control (Sutherland, et

al., 2020). With little money to spend on the right foods to eat for type 1 diabetes it can be a

constant struggle to afford a lifestyle that helps improve their condition.

Solution

All of these statistics lead us into what can be done to solve the growing issue of the

expense for just medication. To begin we can solely base the cost of the medications to reflect

income. Someone with a lower income shouldn’t pay the same as someone with a higher income.

Type 1 diabetes is a lifelong disease and isn’t caused by the person’s lifestyle actions. Allowing

for an affordable cost to all without health insurance ensures the health of these individuals.

These medications are inflated in price and cost those without insurance thousands of dollars

more than it costs to make. Having a system like this we would ensure that people are getting

their medication for what is a reasonable price for them to pay. While this solution could be

fought with some criticism, we already see this system being used in taxes. This new system

would only affect those without health insurance which would allow those with health insurance

to continue their payments through their healthcare policies. While this solution can be seen as

far-fetched it is definitely possible to achieve.

Insulin

To really address this health disparity there needs to be conversation around the lifesaving

drug insulin. There have been many preventable deaths among patients with type 1diabetes

because the means to afford the drug was too high. According to The High Cost of Insulin in the
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 8

United States: An Urgent Call to Action, the price of insulin costs ten times more in the United

States then it does in any other developed country (Rajkumar, 2020). The pervasiveness of

individuals rationing their insulin to save enough money to buy more is too high in the United

States. Not only is insulin expensive but it continues to rise in price yearly. For example, The

High Cost of Insulin in the United States: An Urgent Call to Action states that, in 1999 insulin

was $21 and by 2019 the price rose to $332 which is a 1000% price increase (Rajkumar, 2020).

The interviewee Shannon has allowed for an inside look into affording insulin as her biggest

worry. While this is her biggest worry it is also the worry of millions of people across the United

States. This major concern shows there needs to be an enormous change in the way we view

companies who manufacture and sell insulin.

Solution

The first solution to this heightened issue is to stop companies from controlling a

monopoly over insulin. Once that happens then regulations can be put in place that protect

against companies charging an unreasonable price for the drug. Multiple companies selling

insulin would encourage these providers to lower their costs to compete with others. This

competition can be considerably good for those who don’t have the financial means to pay an

extraordinarily high price for their lifesaving drug. “The High Cost of Insulin in the United

States: An Urgent Call to Action” also states, those who have type 1 diabetes and are uninsured

are vulnerable because they are willing to pay the high costs to have access to their medicine

(Rajkumar, 2020). The United States needs to allow for a system where companies aren’t

profiting from people’s illness. To make this happen there will need to be advocacy as well as

lobbying to get this message to those who can change and make these laws. One of the problems

we see today is that these companies are lobbing very intensively making it extremely difficult to
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 9

have these regulations put into place. This push at the federal level will allow individuals like

Shannon to not worry or stress about if they can afford their next dose of insulin. If these

measures are not put into place, then we will see a cyclical pattern of health disparities of the

inability to pay for years to come. It’s time the government helps stand up for their citizens and

to not bow down to the big corporations.

Healthcare

One of the main reasons their needs to be solutions to the above problems is because of

the framework of the United States healthcare system. This framework is based on if you can

afford to pay you can be treated. If someone can’t then they have to forgo health insurance. The

United States is the only major developed country without universal health insurance. According

to “Uninsured in America: Problems and Possible Solutions” people who are uninsured are more

than twice as likely to report going without needed care because of the cost (Karen, 2007). This

affects those who are diagnosed with type 1 diabetes as they need to see medical providers more

often due to their lifelong illness. As stated by “Health Care Access and Glycemic Control in

Youth and Young Adults with Type 1 and Type 2 Diabetes in South Carolina,” it is a necessity for

patients with type 1 diabetes because there needs to be prescriptions for insulin and glucose

monitoring supplied purchased (Liese, 2019). Being charged the full price for treatment and care

is something these patients just simply can’t afford. In the United States it has almost become a

requirement to indulge in paying insurance companies for protection. It has become cheaper for

those with type 1 diabetes to pay out of pocket for their medicine then it would be to pay for both

health insurance and their medicine. This is where the issue resides. Health insurance companies

have one of the biggest monopoly’s levitating over the United States. They can charge

outrageous prices for their services and still deny you coverage on certain medical expenses.
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 10

Citizens of the United States will pay a high price for insurance which in turn raises the prices

for everyone. With type 1 diabetes health care is essential but many can’t afford it because of

these monopolies. Addressing this health disparity isn’t simple when it comes to healthcare

because of the disagreement that surrounds this topic.

Solutions

Since there is a growing need of health care coverage it is becoming a relevant topic that

there are many solutions to this problem. The first place to start is employers. Each company

small or large should be required to give their employees’ health insurance. “Uninsured in

America: Problems and Possible Solutions” also states that, California’s past governor Arnold

Schwarzenegger has proposed that employers either provide health insurance or pay a fee equal

to four percent of employee earnings (Karen, 2007). This proposed plan would greatly benefit

those who have type 1 diabetes and who are uninsured. It would force their employers to rethink

their benefits when it comes to healthcare. We have learned in the interview with Shannon that

she knows this situation all too well. Shannon works a part-time job and doesn’t receive health

insurance. This is not a one person’s story but a lot of people’s stories with their situation in

health insurance. The next solution would be to implement universal healthcare. This topic is

very unlikely in where we stand at the moment in the United States, but again it is not

impossible. This system works best because it eliminates the monopoly surrounded by big health

insurance companies. The main reason one could claim we don’t have universal health care is

because of these companies. They will do anything in their power to stop a system where

everyone can be seen and treated for free. When there are billions of dollars involved, the money

will talk. They can lobby and pay millions of dollars to congress to say no to bills involving

easier access to healthcare. The big issue in this is that these congressmen take the money and
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 11

say no to bills that would help many American citizens. According to, “Take Action to Ensure

Fairness for Injured Patients” in 2005 health insurers and drug companies gave a combined 6.1

million to the top recipients in each house of Congress (2010). It is nearly impossible for

multiple insurance companies with billions of dollars being made to agree to run them out of

business. While the idea of universal health care is far-fetched right now it will help every

individual with type 1 diabetes to not only receive the care they need, but the medicine they need

to survive. It is imperative that these individuals should no longer be affected mentally from their

financial status and their inability to pay for treatment. Looking into the future there is a brighter

light for these individuals in America. While we may not know when this brighter future will

occur, we do know that advocacy and lobbying will help push the United States into this better

future to those who are uninsured.

Conclusion

Understanding the disparity of the inability to pay for insurance with type 1 diabetes

means to also understand the issues and solutions around this topic. While many individuals

struggle daily to afford their medication there is hope that this flawed system can change. The

solutions mentioned are only possible if the federal government can put forth new laws. As a

developed country the United States shouldn’t lose another life because its citizens are unable to

afford their lifesaving medicine. From medications to insulin to healthcare these solutions can

change millions of lives and its time that we all act now before we fall deeper into a rabbit hole.
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 12

References

Davis Karen. (2007). Uninsured in America: Problems and Possible Solutions. BMJ: British
Medical Journal, 334(7589), 346–348.

Liese, A. D., Ma, X., Reid, L., Sutherland, M. W., Eberth, J. M., Bell, B. A., Probst, J. C., Turley,
C. B., & Mayer, D. E. J. (2019). Health care access and glycemic control in youth and
young adults with type 1 and type 2 diabetes in South Carolina. Pediatric Diabetes, 20(3),
321–329.

Rajkumar, S. V. (2020). The High Cost of Insulin in the United States: An Urgent Call to
Action. Mayo Clinic Proceedings, 95(1), 22.
https://doi-org.libdata.lib.ua.edu/10.1016/j.mayocp.2019.11.013

Sutherland, M. W., Ma, X., Reboussin, B. A., Mendoza, J. A., Bell, B. A., Kahkoska, A. R.,
Sauder, K. A., Lawrence, J. M., Pihoker, C., &Liese, A. D. (2020). Socioeconomic
position is associated with glycemic control in youth and young adults with type 1
diabetes. Pediatric Diabetes, 21(8), 1412.
https://doi-org.libdata.lib.ua.edu/10.1111/pedi.13112

Take Action to Ensure Fairness for Injured Patients. (2010). Health Insurers and Drug
Companies Contributed $26.2 Million to 111th Congress | Consumer Watchdog.
https://consumerwatchdog.org/newsrelease/health-insurers-and-drug-companies-
contributed-262-million-111th-congress.

Ying, A. K., Lairson, D. R., Giardino, A. P., Bondy, M. L., Zaheer, I., Haymond, M. W.,
&Heptulla, R. A. (2011). Predictors of direct costs of diabetes care in pediatric patients
with type 1 diabetes. Pediatric Diabetes, 12(3pt1), 177.
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 13

Tables

Table 1. Annual Cost ($) by Service Category (n=784)

Service category Mean $/person‐year (95% CI) % Annual cost

Hospitalizations 690 (510–871) 15

ER 175 (110–240) 4

Healthcare provider visit 434 (414–454) 9

Education visit 47 (40–53) 1

Medications 1564 (1522–1606) 33

Supplies 1820 (1776–1863) 38

Total 4730 (4516–4944) 100

CI, confidence interval; ER, emergency room.

Source Table 1:
Ying, A. K., Lairson, D. R., Giardino, A. P., Bondy, M. L., Zaheer, I., Haymond, M. W.,
&Heptulla, R. A. (2011). Predictors of direct costs of diabetes care in pediatric patients
with type 1 diabetes. Pediatric Diabetes, 12(3pt1), 177.
INABILITY TO AFFORD HEALTH INSURANCE WITH TYPE 1 DIABETES 14

Figure

Figure 1. Annual Cost of T1D Medication for Uninsured and Insured Individuals

Cost of Type 1 Diabetes Medication Yearly

18,000

16,000

14,000

12,000

10,000

8,000

6,000

4,000

2,000

0
Cost ($) Yearly Cost ($) Yearly

Insured Uninsured

Sources Graph 1:
Ying, A. K., Lairson, D. R., Giardino, A. P., Bondy, M. L., Zaheer, I., Haymond, M. W.,
&Heptulla, R. A. (2011). Predictors of direct costs of diabetes care in pediatric patients
with type 1 diabetes. Pediatric Diabetes, 12(3pt1), 177.

Information from with Interview with Shannon