June 30, 2009

The Honorable Nancy Pelosi                    The Honorable Steny Hoyer             

Speaker                                                Majority Leader                               

U.S. House                                            U.S. House                      

Washington, DC 20515                            Washington, DC  20515  

RE: Healthcare Reform Legislation Must Protect the Needs of People with Limb Loss

The Amputee Coalition of America represents the almost two million amputees across the country.  We are grateful to you for your work on healthcare reform legislation.  We are writing to request your assistance in ensuring that individuals with limb loss are protected from inadvertent harm through reform policies under consideration.  We understand that healthcare reform presents an enormous challenge, however any healthcare reform proposal that truly gets at improving health systems and enhancing access must address the specific needs of people with disabilities. 

We applaud the Tri-Committee draft health care reform bill.  It has many aspects that will make a huge difference to people with limb loss including the new Health Insurance Exchange that will require health insurance to be offered and both premiums and coverage to be set regardless of pre-existing conditions; and caps on out-of-pocket spending. 

People with limb loss must have access to high quality, comprehensive, affordable health care that meets their individual needs and enables them to be healthy, functional, live as independently as possible, and participate in the community. The ACA appreciates and strongly supports your tireless efforts to bring about comprehensive healthcare reform.

However, we are concerned that the pressure to lower the cost of a reform bill could lead lawmakers to inadvertently modify programs and policies that may negatively impact individuals with disabilities:

1)      The Tri Committee discussion draft does not require the essential benefits package to include coverage of assistive devices and related services that enable individuals with disabilities to facilitate their recovery and restore their ability to function and live as independently as possible. We appreciate that rehabilitative and habilitative services are included in that list, but the exclusion of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) as an essential category would result in people with significant injuries, chronic conditions and disabilities going without necessary assistive devices, such as prosthetic limbs and power wheelchairs. A lack of coverage for durable medical equipment, prosthetics, orthotics, and supplies and other assistive devices would have devastating consequences for individuals in need of this care. Congress should clarify in statute that DMEPOS must be covered in an essential benefits package. 

2)      We are heartened that the draft legislation provides new coverage options for people with disabilities through the proposed Health Insurance Exchange and through Medicaid expansion, we continue to believe that Medicare is one of the most appropriate vehicles for providing health coverage to people with disabilities.  In order to protect access to benefits for people with disabilities, Congress must address the two-year waiting period that is imposed on Medicare disability benefits.  If people with disabilities are forced to wait up to two years to receive access to affordable coverage, they will continue to face insurmountable barriers to essential services and/or to be bankrupted by out-of-pocket expenses.

3)       Adequacy of coverage is critically important, particularly to people with disabilities and chronic conditions. Over the years, consumer and patient advocates have attempted to address these gaps in coverage by fighting for benefit protections in state-regulated plans. As a result, most states have used their longstanding regulatory authority over health plans in the non-group and small group markets to enact critically needed benefit laws to protect their residents. If any amendment is proposed that would preempt or roll-back these state benefit laws, we urge you to oppose it.  If adopted, such an amendment could lead to individuals suffering a reduction in their coverage – care consumers have fought hard for and that their state legislatures agree are necessary for adequate coverage.

Thank you for your consideration of our position.  We are grateful for your leadership on health care reform and look forward to working with you in the coming weeks to help make such access a reality.

Sincerely,

Kendra Calhoun              Dr. Jeffrey Cain                          Morgan Sheets

CEO & President             Board of Directors                      National Advocacy Director

Cc:  Hon. Henry Waxman

        Hon. Charles Rangel

        Hon. George Miller

        Hon. Frank Pallone

        Hon. Pete Stark