June 16, 2009

The Honorable Edward M. Kennedy

Chairman

Health, Education, Labor, and Pensions Committee

United States Senate

Washington, D.C.

The Honorable Michael Enzi

Ranking Member

Health, Education, Labor, and Pensions Committee

United States Senate

Washington, D.C. 20510

Dear Senators Kennedy and Enzi:

Re:  Affordable Health Choices Act

The Amputee Coalition of America (ACA) is the leading national organization serving the needs of people of all ages living with the loss or absence of limbs.  We have members, industry partners, peer visitors and support group leaders throughout the country.    

Almost two 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 health care proposals are developed in order to ensure that they are able to lead independent, productive lives.  

We are writing to express our strong support for the draft proposal to reform our nation’s health care system.  The Affordable Health Choices Act will significantly improving access to health and long term services and supports for people with limb loss. 

The ACA believes that the goal of health care reform should be to assure that all Americans, including people with limb loss, 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 proposal released last week goes a long way toward meeting that goal.

Many of the proposal’s provisions will greatly improve the lives of people with limb loss.  We highlight a few to underscore their importance:

Insurance Market Reforms:

The proposals provisions in this area truly represent a sea change in the private health insurance market.   In particular we are extremely pleased that the following is included:

• Requiring guaranteed issue and guaranteed renewal of coverage in the individual and small group markets;
• The prohibition of pre-existing health condition exclusions as well as restrictions to prohibit the use of health status in determining premium rates; and
• The prohibition of annual and lifetime insurance caps and limits on out of pocket spending.

Benefits Categories

We greatly appreciate the Committee’s recognition of people with disabilities’ needs in the benefits categories set forth in this proposal.  The proposal must includes Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DME/POS) -- all of which are critical to enabling people with limb loss and many other disabling conditions to function independently.

It is imperative that a basic benefit package recognize the value of improving functional status, not simply meeting the acute care needs of people with illnesses or injuries.  For instance, a basic benefit package must cover:

·         Intensive medical rehabilitation services provided in the inpatient setting;

·         Post-acute care in a variety of settings to ensure the most appropriate rehabilitation;

·         Outpatient therapies that will restore, improve, and maintain function, as well as such services to prevent the further deterioration of functional status; and

·         A full complement of durable medical equipment, orthotics, prosthetics, and medical supplies, without arbitrary and unreasonable dollar limits or exclusions.

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 subsequent cost to the healthcare system far exceeds that of providing prosthetic care.

If people with limb loss do not have their needs met by private insurance they will ultimately, be forced to avail themselves to the public programs that do offer such coverage.  This result is little different from the current situation for these populations.  A reformed health care system must do better.  Prosthetic and orthotic devices should be seen as an essential part of any benefit package or standard. 

Arms and legs are not a luxury.  Prosthetic limbs are essential items that enable people with limb loss to function as working, tax paying citizens.  These benefits are not luxuries or convenience items.  These benefits are no less important than antibiotics to a person with an infection, open heart surgery to an individual with coronary artery disease, or setting a limb that has been broken.  Congress must explicitly require coverage of these two categories of benefits (i.e., rehabilitation therapies and DMEPOS) in all insurance plans offered under the Exchange and must do so in statute. 

Prevention, Accessibility, Workforce Training, and Health Disparities:

We are especially pleased that the proposal includes the following:

·         Authorization of $10 billion to establish a Prevention And Public Health Investment Fund ;

·         Community Transformation Grants that  include focus on the needs of individuals with disabilities;

·         Development of standards for accessible medical diagnostic equipment; and

·         Inclusion of disability status within data collection on health disparities along with race and ethnicity.

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 hope that our suggestions will help in this complicated process. 

Thank you for your leadership on these critical issues.  We look forward to working with you and your staff to secure passage of meaningful and comprehensive health reform legislation that meets the needs of all Americans this year.

Sincerely,

Kendra Calhoun              Dr. Jeffrey Cain                          Morgan Sheets

CEO & President             Board of Directors                      National Advocacy Director