Healthcare Reform: Creating Access for All Americans Means Access for People With Limb Loss

By: Morgan Sheets, National Advocacy Director

The Amputee Coalition of America 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 healthcare. We are concerned that important items like prostheses and assistive devices that are used 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 is working with the Consortium for Citizens with Disabilities (CCD) to help shape the debate around the principles of true healthcare reform. CCD is a working coalition comprised of over 100 consumer, service provider, and professional organizations that advocate on behalf of persons with disabilities and chronic conditions and their families. The ACA is also participating in quarterly meetings with disability organizations and staff from the U.S. Health & Human Services Department. The meetings focus on the specific impacts and needs of people with disabilities within overall healthcare reform packages or proposals.

We need to look at access, affordability and adequacy!

• Do individuals with limb loss have access to care?
  
  This question incorporates issues of geographic limitations, the availability of qualified providers, challenges with healthcare delivery systems and many other issues.
  
  Additionally, public programs such as Medicaid and Medicare are being discussed as either extensions of or possible models of providing care. This is not a perfect solution for amputees given the fact that the Medicare program has a two-year waiting period for people with disabilities to become eligible.
  
  

• Are individuals with limb loss able to afford care?
  
  Whether we are talking about the extreme limitations private insurance companies are putting on prosthetic benefits or the fact that state Medicaid benefits for prosthetic devices vary greatly, there are already major barriers to the affordability of prosthetic devices. Any wide-scale reform must take these issues into account.
  
  

• Is the coverage adequate for people with limb loss to reach their full potential?
  
  Currently, many private plans include rigid restrictions on coverage for repairs and replacements, even for children who need new devices as they grow. Benefit packages or parameters that are developed as part of healthcare reform must ensure that the care is adequate to truly meet peoples' needs.

We are 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 including people with limb loss.

Non-Discrimination: People with disabilities of all ages and their families must be able to participate fully in the nation's healthcare 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 frequent users of care into separate or government-sponsored programs. Non-discrimination requires that the healthcare financing system:

• prohibits rating practices that discriminate against those who use healthcare more intensively;

• 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 healthcare 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 healthcare 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 healthcare 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 based on individual need, preference, and choice.

The issue of consumer choice and participation has a particular importance for persons with disabilities. An appropriate healthcare 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 healthcare personnel.

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

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

• limits out of pocket expenses and cost-sharing requirements for participants;

• provides access to services based on healthcare 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 frequent 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 healthcare 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 healthcare 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 healthcare 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 healthcare system that supports continuity of care:

• includes as a major component of the system a seamless continuum between healthcare 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.

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.

We understand that healthcare 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.

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The Amputee Coalition of America is proud to be part of the Consortium for Citizens with Disabilities (CCD). These principles are based in part on the CCD's healthcare reform principles. To learn more about our healthcare reform work or our other congressional efforts, contact us at 202/742-1886 or federal@amputee-coalition.org