January 7, 2009
Tom Daschle
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Mr. Daschle,
On behalf of the leading consumer organization representing people affected by limb loss in the United States, we would like to congratulate you on your nomination to lead both the Department of Health and Human Services and the new White House Office of Health Reform. Your record, experience and leadership will certainly be assets to the Obama administration as they work to addressing this country’s health care crisis.
These challenges are certainly felt by many of the almost two million amputees across the United States who are face personal health care dilemmas in the form of restrictions, limitations and exemptions on their coverage. Insurance coverage in both the private and public sector is variable and often inadequate to meet individual needs. Amputees are being refused insurance benefits that they need to live active and productive lives, and frankly, we believe this is just wrong—arms and legs are not a luxury.
Those people with limb loss with less functionality who seek public health coverage under the Medicare program for severe and long term disabilities are faced with two year waiting periods and limitations on the availability of assistive devices to enable them to reach their full potentials.
On behalf of the almost two million people living with limb loss, we offer the following suggestions for developing and enhancing policies within the Department of Health and Human Services as well as in your role as the head of the new White House Office of Health Reform to help meet the needs of people with disabilities.
Support the passage of the Prosthetic Parity Act (HR 5615/S 3157) requiring private health insurers to provide parity in coverage for prosthetic care.
Currently, many health insurance companies are capping prosthetic arms and legs benefits too low for the average person to obtain a prosthesis. Some insurance companies provide coverage for only one prosthesis per lifetime. On average, an adult amputee will need a replacement every five years, and children more frequently as they grow.
The lack of access to prosthetic devices leads to poor rehabilitation outcomes, and places amputees at a greatly increased risk of developing dangerous and costly secondary conditions such as obesity, diabetes, cardiovascular disease and additional amputation.
Secondary complications lead to decreases in mobility, productivity and the ability to live independently, which conspires to create additional costs of care, significantly impact the quality of life and shorten life expectancy.
The Prosthetic Parity Act (HR 5615/S 3157) creates a consistent standard of coverage offering adequate benefits to allow amputees to lead active lives and has bi-partisan support in the House and the Senate.
Phase out the two Year waiting period for Medicare coverage for people with severe and long term disabilities.
While most of the approximately, 2 million amputees under the age of 65 are able to work full-time and maintain health care coverage under employer-supported insurance plans. However those with less functionality may seek public health coverage under programs such as Medicare for severe and long term disabilities. Unfortunately, there are several policies that are currently impeding Medicare recipients from reaching their full potentials.
Phase out the two Year waiting period. Unlike older Americans, who typically enroll and become eligible for Medicare coverage within months of turning age 65, disabled beneficiaries must wait two years before their coverage takes effect. Legislation to phase out the waiting period over ten years has been introduced in the House and Senate (HR 154/S 2102). As President Obama’s administration works to address America’s health care crisis, we urge you to place a high priority on closing the gap in coverage that affects a group of Americans most in need of guaranteed access to health care—people with severe disabilities who are waiting to become eligible for Medicare coverage.
Modify the “in the home” restriction on Medicare coverage for assistive devices to allow for coverage for community use.
Currently, Medicare only provides coverage for mobility devices that are necessary for use inside a beneficiary’s home. They will not provide an assistive device if they need it to return to work or participate in activities such as church or school. The Medicare Independent Living Act of 2007 (HR 1809) eliminates the "in the home" restriction on mobility devices. The ACA is calling on the new administration to modify the “in the home” restriction through the regulatory process in order to improve access to the community for people with disabilities. This will allow people to have access to the devices they need to go to work or school, to get to a doctor’s appointment or just live a more active, independent life.
Partner with the ACA and other disability rights organizations to ensure access to prosthetic and other assistive devices in any comprehensive health care package or health system overhaul.
The ACA is thrilled to hear about the efforts that President elect Obama and members of Congress are making to see to it that all Americans have access to health care. We are concerned that important items like prostheses and assistive devices that are utilized by a small portion of the population will be left out of the discussion. It is important that prosthetic care is not left out whatever administrative or legislative solutions the administration looks to advance.
The ACA would welcome the opportunity to work with you to address these important issues. We wish you all the best as you prepare to take on these very important roles. As the transition progresses, if we can provide you with any additional information, please contact ACA National Advocacy Director Morgan Sheets at 202/302-4373 or msheets@amputee-coalition.org.
Sincerely,
Kendra Calhoun Morgan Sheets
President & CEO National Advocacy Director