The ACA Fights for True Healthcare Reform

By: Morgan Sheets

One of the biggest challenges and opportunities for the U.S. Congress this year is its attempt to reform our healthcare system to provide access for the uninsured and to improve and enhance the availability of care and delivery systems for all Americans. The Amputee Coalition of America feels strongly that any healthcare reform proposal aimed at true reform must address the healthcare needs of people with limb loss. 

To ensure that the needs of amputees are being heard, the ACA launched a legislative initiative on healthcare reform this year. We have been meeting with staff from various congressional offices for the past six months. We have participated in several coalitions trying to advance the needs of people with disabilities within the reform debate. We have submitted comments and letters on the various proposals and bill drafts. We have been working with our activists to hold in-district meetings to raise awareness about healthcare reform and to build support for our prosthetic parity bill. We have sent action alerts to mobilize our activists to make calls and send e-mails. Recently, we participated in several national call-in days harnessing the activism of the disability community to flood the Capitol switchboard with calls and get our message through.

Great progress has already been made. The current drafts include insurance market reforms prohibiting pre-existing health condition exclusions, as well as restrictions to prohibit the use of health status in determining premium rates. They also prevent the imposition of annual and lifetime insurance caps and create limits on out-of-pocket spending.

Congress has also been working to create a more comprehensive category of health disparities, which would include people with disabilities. The work that is being done regarding health disparities is intended to develop innovative research and create strategic initiatives to prevent disability-based disparities in care. These include educational campaigns to decrease amputation rates by helping screen low-income patients to ensure early diagnosis of peripheral vascular disease (PVD). Another initiative would be to include individuals with disabilities in all data collection and reporting mechanisms to identify access issues and develop appropriate standards of care and treatment.

Part of the goal of the healthcare reform process in Congress is to create minimum standards of coverage for any plan that is developed as part of either a new exchange market or a public option. The ACA and several of our partners have been working to ensure that the standards include specific language to provide a full complement of durable medical equipment (such as wheelchairs), prosthetics, orthotics and services (DMEPOS) and other assistive devices. This is essential to ensure that people with limb loss are given the care they need to reach their full potential.

Without appropriate prosthetic and orthotic care, many people with complex, disabling conditions are at risk of developing dangerous and costly secondary complications. Furthermore, the delay in appropriate care has a profound impact on the ability of individuals to maintain and enhance function, become and remain independent and to reach their full potential.

The Affordable Health Choices Act successfully passed through the Senate Health, Education, Labor and Pensions (HELP) Committee. After hard work by our activists, our partners and thousands of disability advocates, we are thrilled that the Affordable Health Choices Act includes coverage of rehabilitation and habilitation devices and services in the essential benefits package. This statutory language establishes coverage for DMEPOS, which are critical to people with limb loss. 

The current version of the House Education and Labor healthcare reform legislation includes language ensuring access to DMEPOS. The ACA will continue to push to ensure that the final House and Senate versions include protections for access to assistive devices.

The ACA is also working to make sure that state benefit requirements are protected. Many states have passed laws to ensure that gaps are not left in the coverage for people with disabilities by using 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. We are urging members of Congress to oppose any amendment that would preempt or roll back these state benefit laws. Such an amendment could lead to a drastic reduction in coverage.

Finally, we are also working in a coalition to address the Medicare 2-year waiting period. While most of the 40 million Americans covered under Medicare are age 65 and older, nearly 6 million qualify because of severe and permanent disabilities. Unlike older Americans, who typically enroll and become eligible for coverage within months of turning age 65, disabled beneficiaries must wait 2 years before their coverage takes effect. If people with disabilities are forced to wait that long 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.

Almost 2 million Americans are living with limb loss or limb deficiency as a result of disease, trauma or birth defect. As the emerging public health crisis of diabetes continues to escalate, so will the number of amputations. It is essential that the needs of people with limb loss are taken into consideration as healthcare proposals are developed to ensure that they are able to lead independent, productive lives.

The healthcare reform battle is ramping up in Congress. Discussion will likely begin on both floors by the end of July, though it looks more likely that the floor debate and votes will happen after the August recess. It is imperative that we work hard to push for the needs of amputees. We need your help to tell members of Congress where we stand on healthcare. We must work together to make comprehensive, high-quality healthcare for all a reality.

Sheets is the national advocacy director for the Amputee Coalition of America. To find out more about our healthcare reform initiatives or to get involved, visit www.armsandlegsarenotaluxury.com