LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Monday, October 28, 2013

Giving up

I was born in Missouri. I know that they call themselves the “show me” state, but I never thought that meant that I’d be required to show the federal government that Big Mo has been part of the Union since 1821.

But apparently so, because according to the health insurance marketplace, my immigration paper work is not in order so I may not, at this time, apply for health insurance.

And, yes, I DID check the “US Citizen” button. Five times, in fact. And each time I was informed that my immigration documents could not be verified.

But that’s not the only bug I encountered in my effort to confirm that I cannot afford to buy insurance on the new Exchange (it’s called an exchange because you exchange your hard-earned cash with an insurance company for a product of dubious value). Now, apparently, my wife is married to another woman. But for all you guys out there with lesbian-sex fantasies, forget it. The woman she’s married to is herself. I’m not going to get into the potential Freudian aspect of this, but it would clearly take both a time machine an unusual personality to make that work. Still, the site is convinced that my wife is married to herself and I’m married to, well, apparently, no one. So I guess I’m back on the market in at least one way.

So now what?

I have not added up the number of hours I’ve spent on this futile task, but I’ve decided to take a break. I’ll give them a month to see it they can sort it out and get this mess of a website working.

I know that my health insurance goes away December 31. And I know that, on the face of it anyway, it’s unlikely that I’ll be able to afford to replace it, even if I could sign up for it. But you know what? Even though it seems like just the other day it was summer, right now two months sounds like a long time away. I’m putting this off.

The future will hold what stresses it may, and I’m out of energy to deal with it. Maybe next time I try to sign up, my wife won’t be married to herself and I’ll have two wives.

Hey, with this computer system, it really could happen.

Sunday, October 20, 2013

Not your typical trip to the market

So last weekend I went to my State’s exchange where bright, colorful graphics in yellow, red, and turquoise and bold type fonts assured me that not only will I “Be Well,” but that I’ve arrived at the place that is “Finally, a simple way to get affordable health insurance.”

Well thank goodness for that. It’s about time.

Then the popup pounces.

It understatedly says that due to the heavy volume on the federal website, “those shopping for individual and family insurance plans may experience difficulty signing up.” Of course, they are sorry for the inconvenience.

You see, my bluish state has a red governor at the moment. She pussy-footed around long enough that we weren’t able to build an exchange of our own and have to the use the fed’s site. Except, as everyone knows, the fed site isn’t working. (To her credit, Madam Governor did later put the citizens of our state above partisan politics and expanded Medicaid.)

Anyway, I followed the link to the fed’s site and started to sign up. For me, at least, the first phase of the processes wasn’t as bad as many others have reported. It was tedious, but not difficult. The site never crashed on me. It was as slow as a dial-up modem in the old days, but I was able to plug along. It took me about two hours, most of it waiting for each page to load, and answering and confirming the same questions over and over again. It made me wonder why we the people of the United States didn’t just hire Steve Zuckerberg to build the exchanges? Facebook seems to handle heavy volume pretty well.

But little did I realize at the time that by filling out the forms honestly, I was setting myself up for no end of woe. Now, I want all of you to know that I’m not whining about my money problems, but I need you to have some background to understand what happened to me next. Like many Americans, I made less money this year than last, and next year—barring any miracles—I will make still less again. I don’t think I’m alone in this boat. It’s a struggle, but I’m not feeling sorry for myself. Well, not too sorry, anyway. But the federal Exchange site, as you will soon see, is not set up for the possibility of citizens having sinking standards of living, which strikes me as insane, because I perceive this as the norm.

How much am I down? Does it make a difference? At my clinic, we are all working under a 5% pay cut this year. The cost of writing off healthcare for all the recently uninsured folks is swamping the boat. Plus the insurance companies “covering” those who remain covered are always finding new and creative ways to deny paying us for care we’ve given. The only way to keep the lights on was to pay everyone in the trenches less. I doubt making 5% less would have much impact on the premium cost for a health plan, but that’s not all I’m dealing with in the bank account department. As you all know, I lost my University job this year. Happening late in the year, that has more of an impact on next year than it did on this year. But of course, the cost of health insurance through the exchange is supposed to be based on what we will earn in 2014. On top of all of that, one of my writing gigs is on tough times and my pay there is down about 50% since March. But wait, there’s more! A magazine I used to write for a lot got a new editor who doesn’t like my work, and the magazine that the editor who did like my work went to doesn’t have a freelance budget. Other places I write for simply assign less as they tighten their belts. And of course, in a bad economy book sales are down and royalties right with them. The bottom line is ugly, but I did my level best to estimate how much less I’d be earning and entered all that data. By conservative estimate, I’ve taken about a 30% hit on my gross income.

And that’s enough to make a pretty big difference on what Marketplace insurance should cost me on the Exchange.

Finally, when I was done, pressed the last button, waited and waited and waited for the final page to load. Then I got the magic message: my Marketplace “Eligibility Notice” was waiting. It was a PDF, but wouldn’t open or download for love or money. I even downloaded a fresh copy of Adobe Reader, but still no luck. I tried my iMac, my wife’s iPad, and my iPod. Finally I dragged an old crash-prone PC out of the back of a closet and booted it up. Three crashes later, I was able to view my 13-page eligibility notice.

And it, in essence, said I was not eligible to view my options for health insurance until I could prove that I will make less money in 2014 than I did in 2012. I was instructed that I had to snail mail to the Marketplace proof I would make less. They suggested signed letters from my employers certifying that they would be paying me less.

You’ve got to be fucking kidding me.

Obviously, for someone like me with multiple streams of income, this isn’t doable.

I decided to just change the application to say I expected to make the same as I made in 2012. I’d pay more, but at least I could see what I’d pay for real, instead of just relying on estimates from the Kaiser foundation calculator.

I went back into the federal website and found my application was carved in stone. No changing it, apparently.


So I spooled up the live chat to ask for help. I won’t torture you with the details of that conversation. I was treated with great suspicion and all but called a cheat and a liar for wanting to change my income data. In the end, I was told an I.T. specialist would have to unlock my application so I can make changes. Said specialist would call me in 48 hours. If I didn’t hear anything in 48 hours I should contact the Marketplace again.

After 72 hours, I contacted the Marketplace and repeated my story. This time they wanted to know when I could and couldn’t be reached. I told them I could be reached any day but Tuesday, Wednesday, or Thursday.

Naturally, they called back on Thursday and left a message saying they had tried to call me and if I was still having problems I should call them back.

Picture steam coming out my ears.

Next time: Apparently my wife is married to another woman and I’m not a citizen

Saturday, October 12, 2013

Hey brother, can you spare a dime?

There was a green piece of paper stapled to my pay stub. Never a good sign. Well, I thought, at least it isn’t pink. Yes, my job was safe—it was my health insurance that got laid off. The green note told me that the company’s health insurance, which has gone up by leaps and bounds over the last few years, was set to go up another whopping 25% next year, and my employer was throwing in the towel. They can’t stay in business and provide us health insurance.

I was cast upon the Exchange.

OK. I can do this.

The first stop, recommended by my employer, was the Kaiser Family Foundation, where they have an online calculator that estimates what a plan will cost based on your age, family size, income, location, and what not. It also estimates how much help you might get in paying the tab. As a reminder, the law requires all of us to get insurance, but lower income folks are supposed to get a subsidy to help pay the tab.

So I entered my state, my zip, what I thought my income was last year, the fact that my employer kicked my insurance to the curb, the number of people in my family, my age, my wife’s age (her real one, not the one she tells everyone), admitted I was a tobacco user, logged one living child, and confirmed that HE was not a tobacco user—no shit, it asks—then pressed the submit button.

One second later I had the answer.

Two seconds later I thought that there must have been some kind of mistake.

Because my estimated premium for health insurance was 19.7% of my annual pre-tax income. Maybe. Actually, it might be a lot more. There was a little note that said “In most states, insurers can charge a tobacco surcharge of up to 50% of your total premium.” It went on to say that any subsidy I got could not be applied to this surcharge. So that raises the base premium to 29.62% of my gross income. For those of you not of a business bent of mind, gross income is my pre-tax income, not what I get to “take home.” This means the premium would take an even bigger bite out of the household budget than it looks like it would. And it gets worse. About half my income is from various forms of self-employment, all of which are not only taxed at a higher rate, but we self-employed folks pay both the employer and employee share of social security taxes, reducing our take-home pay by 13.3% before we even get to the income taxes. (Don’t freak out, in your state the health plans may be cheaper, and if so, I may have to migrate there).

All of that combined means there is no fucking way I can afford to pay for health insurance. Literally. When the bills are paid, there ain’t much left. This premium would require a hair over a third of my take-home pay, and like most Americans, I’m juggling bills and living paycheck to paycheck.

Right now I’m very spoiled. I have awesome Canadian-style insurance that I only paid like $45 a month for. Of course my pay is low, but I always viewed good insurance as the counter balance for that. So I checked in with my boss, Hey, these exchange premiums are really insane. Will the company be helping me out with them in some way?” The response? “We cannot legally supplement premium costs for those on the exchange.” Followed up with, “I am sorry about all this—the aches and pains of the Affordable Care Act will take several years to resolve, and your situation is one that will be painful while it does.”

Ya think? Well, I’m sorry too. I work seven fucking days a week to help people with diabetes be healthy and I can’t even afford health insurance? It’s bitterly ironic. It would be funny if my life weren’t in the balance.

But wait, what about that subsidy? The help I’m supposed to get from the government. Won’t that knock something off the tab? Yes. And in my particular circumstance they will pick up 55% of the non-tobacco share of the premium. (OK, I could give up my evening cigar, but I have to be smoke-free for something like five years before I don’t have to pay the surcharge.) That subsidy sounds generous on the surface, but it’s not nearly enough to make this workable. The premiums would still be a budget-busting check what would exceed 23% of my monthly take home pay every month, a premium/surcharge check that surely would bounce if I had the courage to write it. But let’s say we lived without electricity, heat, and running water and gave nearly a quarter of my take-home pay to the local insurance company. How well would my new insurance cover my health needs?

About one quarter short of a dollar.

All the estimates the calculator gave me are based on the “Silver” plan. For those of you who don’t know yet, all exchange plans come in four flavors: Bronze, Silver, Gold, and Platinum. The only difference is in how much you pay out of pocket vs. how much the plan pays for covered services (what is covered and isn’t covered is as much a mystery as ever). The percentage covered by the plan ranges from 60% for bronze to 90% at the Platinum. Of course, to get Platinum coverage you need to pay a Platinum Premium. 

Anyway, at my estimated Silver level I would need to pick up 30% of my doctors visits, lab tests, imaging, and prescriptions. Frankly, that’s the one that scares me shitless. Thirty percent of the cost of a vial of rapid-acting insulin is $49.46. Thirty percent of a vial of basal insulin is $56.99. Thirty percent of a pair of Victoza pens is $102.73. Thirty percent of a month’s supply of test strips is $54.00. Altogether that’s $263.18. And we haven’t even gotten started. How well will durable medical goods will be covered? How much will my CGM sensors cost me? And if I decided to go back on a pump, the total medical costs would exceed my income! Well. Actually, they won’t. After all, there is an out-of-pocket limit.

Of $12,700 a year.

If you work the math, and please don’t, in my case when I add my premium, surcharge, and my maxed-out out-of-pocket expenses, it works out to something like 51% of my income. My pre-tax income.

Oh, and I also have to pay for 30% of mental health and substance abuse treatment, both of which I’m thinking I’m going to need real soon.

So what’s my option? I can choose to opt out and pay a fine. Next year it will be 1% of my income. The year after that it would be 2%. Sounds like I can opt out for a long time before I’m paying fines of 51% of my income. Would I be better off paying the fine and putting that money towards my meds and gear? Yes. Unless I ended up in the hospital for some reason, get run over by a truck, fell out of a plane, get cancer, or whatever.

What triple sucks is that I’ve always been a supporter of this reform. I don’t mind paying more and getting less if we are moving forward as a society. And I’ve always believed that people who whined about the law were (a) bad citizens who don’t care about their fellow man or (b) unrealistic idiots who couldn’t see the handwriting on the wall. I’ve been saying all along that if you think your insurance is good, you haven’t used it; and If you think your insurance is stable, you haven’t talked to your employer recently.

During the debates the nay-Sayers wailed and gnashed their teeth about who would pay for “Obama Care.” No one asked the real question: Who will pay for doing nothing? The train was out of control. Double digit cost increases can only go on so long before the costs exceed all the money in the world.

I knew my coverage would be worse this winter, but I knew it was worse than bad for so many others right now. I was happy to move down the ladder a few rungs so the people down below could climb up a few. I also knew I’d be paying more for that worse insurance, but I was OK for that. We’re all in this together. It just never occurred to me that it would be quite literally unaffordable.

That rather than move down the ladder I would fall off of it.

Next time: Navigating the Exchange. Or trying to, anyway…

Wednesday, October 02, 2013

The return of the Space Food Stick

When I was a kid, we put three guys on top of a bomb and lit the fuse. Oh, the “we” I’m referring to wasn’t my family, it was our country. When the bomb went off, it launched the guys to the moon. It also launched quite a few other things back home, as well.

My personal favorite among the early consumer spin offs from the space program was the Pillsbury Space Food Stick. These were small individually-wrapped fudgy, chocolaty tubes that the astronauts were supposed to be eating on the way to the moon (while drinking their Tang). They were soft, and didn’t create crumbs. A good thing in zero gravity, my dad explained to me. He wouldn’t get them often, and they didn’t fill me up enough for a meal, but they were great snacks. I doubt they provided the kind of nutrition a growing boy needed, but they fueled my flights of fancy while jumping around my front yard trying to imagine what it would like to walk on the moon with its 1/6 gravity.

 Naturally, I was dismayed to learn at the Museum of Space History a few years ago that Space Food Sticks weren’t on the menu on the way to the moon. It was just clever marketing. Anyway, like many other things in life that I loved as a kid—boxed Noodles Romanoff, Sarah Lee frozen brownies with the shiny icing, and Bugles corn snacks eaten off each fingertip—I never expected to taste a 1970s Space Food Stick again.

What on earth got me on this topic today? Well, being such a “famous” blogger, I get dozens of press releases every day from PR firms trying to hock all manner of goods to the Diabetic Population. My stock answer is: Send me a sample of whatever it is, and I’ll think about it.

Well, along with an automatic pill dispenser the size of a typewriter, super-warm winter socks fit for Ice Station Zebra, and a half-dozen uninspiring cookbooks, I got a box of these:

 They were billed as being gluten-free, low sugar, stevia-sweetened food bars—so you can see why I was in no hurry to try them. Plus, they were not the first D-friendly “food” bars I’d received. The box sat next to my desk unopened for a few months. Then last week, I got disorganized and ran out of Kind Bars, my go-to daily breakfast. Desperate times call for desperate measures. I took a risk and opened the Promax LS energy bar box. The bar was small, and heavy. I prepared myself for another “healthy” incarnation of sawdust. I was so suspicious that I decided to hold off on my bolus until after the first bite.

I opened the strange, matt-finish paper-like foil pouch, sniffed at the bar suspiciously like a stray dog does, then took a bite. All of a sudden it was 1971. I was eight years old, and I was eating a Space Food Stick again.


And I’m not the only one who finds the Promax bars yummy. I made the mistake of letting 11-year-old Rio eat one, so he could see what a Space Food Stick tasted like, and now the box is suspiciously empty.

There are some other differences between the past and the present beyond the shape. On the dark side of the moon, the Promax bar is chocolate-coated, and the coating is crumbly. The crumbs are likely to break off and float around your space capsule, gumming up your instruments (or staining your khakis). But on the bright side of the moon, the new Promax bars are more filling, and I find one holds me just fine until lunch.

The specs are 140 calories, 21 carbs, and 9 grams of fiber. One bar has about 10% of your key vitamins and minerals, and about a quarter of the protein your body needs for the day.

But the most important difference between Space Food and Promax is that there are no rockets. I’ve eaten three Promax bars so far, and my blood sugar has stayed firmly down to earth each time.