→ Background: The ACA is thrilled to hear about the efforts that President 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.

→ Status:  We will continue to meet with lawmakers and other key leaders to ensure that the policies take into account the particular needs of people with limb loss, as well as to work with our coalition partners and policy leaders to shape the discussion around this important policy initiative.

Principles for Health Care Reform From the Perspective of People with Limb Loss

The ACA understands that health care reform presents an enormous challenge.  We feel that any healthcare reform proposal that truly gets at improving health systems and enhancing access must address the healthcare needs of people with limb loss.   

We are specifically focused on a number of principles that must be met for any benefit package or policy concept to truly meet the needs of all Americans.

Non-Discrimination: People with disabilities of all ages and their families must be able to fully participate in the nation's health care system.

Discrimination occurs when a sizeable proportion of people with disabilities are denied insurance or subjected to preexisting condition exclusions. It also occurs when systems are designed to segregate high users of care into separate or government-sponsored programs.  Non-discrimination requires that the health care financing system:

• prohibits rating practices that discriminate against higher users of health care;
• provides access without regard to health or disability status on par with access provided to those without disabilities or chronic conditions; and
• ensures portability of coverage.

Comprehensiveness: People with disabilities and their families must have access to a health care system that ensures a comprehensive array of health, rehabilitation, personal, and support services across all service categories and sites of service delivery.

Comprehensiveness implies the broadest set of services that assist individuals with disabilities and their families to achieve and sustain optimum physical and mental function. People with disabilities would most benefit from a health care system that includes access to:

• preventive services, including services to prevent the worsening of a disability;
• habilitation services and rehabilitation services designed to improve function over time, not just stabilize the health status of a patient with an acute health care condition;
• durable medical equipment, orthotics, prosthetics, and other assistive technologies and related services that do not include inequitable limits and restrictions.

Appropriateness: People with disabilities and their families must be assured that comprehensive health, rehabilitation, personal, and support services are provided on the basis of individual need, preference, and choice.

The issue of consumer choice and participation has a particular importance for persons with disabilities. An appropriate health care system is one which:

• ensures consumer choice in relation to services and providers;
• ensures appropriate amount, scope, and duration of services; and
• ensures the availability of trained and qualified health care personnel.

Equity: People with disabilities and their families must be ensured equitable participation in the nation's health care system and not burdened with disproportionate costs.

Health care reform must ensure that people have access to services based on health care need and not on their employment status or income level. An equitable health care system would be one which:

• limits out of pocket expenses and cost sharing requirements for participants;
• provides access to services based on health care need and not on income level or employment status;
• ensures access to the insurance market for people with disabilities below age 65, including access to COBRA coverage as a wrap-around benefit, Medigap policies, and individual insurance that is community rated;
• does not use public programs such as Medicare and Medicaid as the preferred insurance mechanism for high users of care; and
• provides reimbursement for service providers that is adequate to ensure access to care.

Efficiency: People with disabilities and their families must have access to a health care system that provides a maximum of appropriate, effective, quality services with a minimum of administrative waste.

The CCD is concerned that the current fragmented system has failed to achieve effective cost controls, or a rational allocation of health resources, and contributes to substantial administrative waste. An efficient health care system is one that:

• reduces administrative complexity and minimizes administrative costs;
• allocates resources in a more balanced way between preventive services, acute care, rehabilitation, and chronic care management; and
• ensures the delivery of clinically effective services.

Continuity: People with disabilities and their families must have access to health care that responds to their needs over their lifetimes and provides continuity of care that helps treat and prevent chronic conditions.

Adults and children with developmental and other disabilities often need long-term services and supports that enable them to live as independently as possible and participate in their communities. A health care system that supports continuity of care:

• includes as a major component of the system a seemless continuum between health care and long term services and supports;
• emphasizes home and community based services and, by doing so, reduces the need for institution-based care;
• includes benefits that serve to maintain as well as restore functional status, including lessening the deterioration of function over time; and
• enables families to provide care for family members with disabilities of any age in the most appropriate setting.

The Amputee Coalition of America is proud to be part of the Consortium for Citizens with Disabilities (CCD).  The CCD is a working coalition comprised of over 100 consumer, service provider, and professional organizations which advocate on behalf of persons with disabilities and chronic conditions and their families.  These principles are based in part on the CCD’s health reform principles.