Opinion

Key ACA Provisions Help Keep 32 Million Americans with Food Allergies Safer

By Josie Howard-Ruben & Julianne Doucette
May 23, 2019 at 5:00 am ET

While most of the nation was fixated on deconstructing the Mueller report and Attorney General William Barr’s appearance before the Senate Judiciary Committee, the Justice Department joined with a group of states seeking to upend the Affordable Care Act, filing a brief in 5th U.S. Circuit Court of Appeals in New Orleans.

By asking the appeals court to uphold the ruling that the individual mandate is unconstitutional, the administration telegraphs its intent that the entire ACA law be struck down. The Associated Press reported that the administration’s filing argued that “the remaining provisions of the ACA should not be allowed to remain in effect — again, even if the government might support some individual positions as a policy matter.”

Americans voice support for many of those individual positions, but it appears the administration isn’t listening. Regardless of party affiliation, 68 percent of Americans favor lowering prescription drug costs. Making sure that protections for those with pre-existing conditions remain in place is also favored by 70 percent.

If court rulings ultimately result in the demise of the ACA, some of these favored provisions could be eliminated. A majority of voters now do not want to see the ACA overturned.

Changes in health care coverage are especially important for those coping with food allergies. In an editorial on his SnackSafely website, allergy blogger Dave Bloom warned repealing the ACA could lead to care and coverage repercussions.  

If not specifically prohibited, insurers could eliminate coverage of care for pre-existing allergies; costs of policies could rise to the point of unaffordability; or policies could be discontinued altogether, Bloom said. A pre-existing condition is defined as a health problem experienced before the date that new health coverage starts.

A definitive list of pre-existing conditions does not exist, although the list of potential pre-existing conditions reads like a medical textbook, ranging from acne and anxiety to cancer and heart disease. Food Allergy Research and Education states that about 32 million have food allergies, meaning 1 in 10 adults in the U.S. population are affected — that’s a lot of pre-existing diagnoses. On the heels of Food Allergy Awareness Week, highlighting how these changes can impact those with food allergies is timely.

The public perception of a person with food allergies is a child with peanut allergies, but nearly 8 percent of U.S. children are allergic to a variety of foods besides peanuts, including tree nuts, soy, milk, eggs, wheat, shellfish, finfish and sesame. Food allergies frequently persist from childhood to adulthood, and many are never “outgrown.”

Adults can develop new allergies at any point, with one retrospective chart review indicating a peak incidence in the early 30s. FAIR Health, an independent nonprofit that reviewed over 24 billion private insurance claims spanning 10 years, reported that food allergy claims are increasing.

In its analysis, adults accounted for about one-third of the claims for food allergy diagnoses; claim lines for anaphylactic food reactions grew by 377 percent. Food allergies impact Americans across the lifespan.

Health care coverage needs for food allergy management and treatment transcend all age groups, making one of the popular elements of the ACA particularly salient. Under the current provisions of the ACA, adult children can stay on their parent’s health care plan up to their 26th birthday, when they can then qualify for a special enrollment outside of the ACA’s open enrollment period, allowing for seamless health care coverage.  

The extension of dependent care coverage provides young adults with an important safety net as they transition to their own plans. Without dependent coverage, protection of pre-existing conditions, and insurance coverage of emergency medications, these young adults might be forced to choose to spend their limited salaries on rent, tuition or other bills before filling prescriptions. Protecting access to care and treatment for our families is imperative and can’t be a casualty of politics.

Children, young adults and adults with food allergies all require care by an allergist and sometimes other specialists; over-the-counter and prescription drugs; prescriptions for epinephrine auto-injectors; other allergy treatments like immunotherapy; and sometimes special, more expensive foods or formulas.

The expense associated with these treatments can be substantial. The out-of-pocket cost of obtaining the devices varies dramatically, with co-pays ranging from $0 to well over $500 for two auto-injectors, and in some cases, over $1,000.  

Often, low-income patients who do not qualify for Medicaid simply skip filling their prescriptions for these life-saving devices, relying on 911 for transport to the emergency department for treatment. Delayed administration of the epinephrine auto-injector increases the risk of hospitalization, as well as a possible stay in the intensive care unit, resulting in a high-cost episode of care.  

On the contrary, timely administration lowers the risk of both hospitalization and fatality, so affordable access to epinephrine is truly a matter of life and death. Over the past year, the availability of epinephrine by auto-injector — the emergency medication needed to treat food allergy anaphylaxis — has been haphazard at U.S. pharmacies, so ensuring their availability and affordability remains an ongoing concern. Fortunately, more options for epinephrine are available, but accessibility continues to be an issue.

People living with food allergies have enough to worry about. Scrutinizing every food label, planning for trips outside the home, and exercising caution at every meal take their emotional toll. Inadequate insurance coverage for food allergy treatment and medications, or limits on that coverage, should not be added to their list of concerns.   

Allergies might be considered “invisible disabilities,” and their care shouldn’t be left to the vagaries of legislative gamesmanship. Coverage for food allergy treatment and medication should not be in peril. Politics cannot trump access to essential care for so many dealing with life-threatening food allergies.

 

Josie Howard-Ruben is an assistant professor at Rush University College of Nursing and a public voices fellow through The OpEd Project and has family members with food allergies.

Julianne Doucette is an assistant professor and associate program director of the Primary Care Pediatric Nurse Practitioner Program at Rush University, and she has a son and a daughter with food allergies.

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