Major progress is being made in the federal effort to push for wide scale health care reform, however recent discussions have brought up several concerns for the ACA and our members. 

▪ Access to/coverage for prosthetic and orthotic devices 

We need to stress the importance of providing the care needed to improve and maintain functionality.  Prosthetic and orthotic devices should be seen as an essential part of any benefit package or standard. 

▪ Out of pocket expense limits  

Many people believe a very minimum set of standards will be developed, rather than a very specific package.  This raises questions around how people with disabilities will be able to meet their health care needs.   The standards must take into account the out of pocket expenses that are being imposed on individuals, as well as particular groups.  Out of pocket limits and/or cost sharing for vulnerable populations must be emphasized. 

▪ “Board” membership (inclusion of consumer representatives)

The current directions is to create a board that would develop the basic standards/package.  It is uncertain what this board will look like and who will be on it.   We need to ensure that the workings of this committee will be transparent.  The board should also include consumer representation. 

▪ State mandate protection  

It is unclear how existing state mandates will affect or interact with the minimum benefit package under health care reform.  The ACA is concerned that the mandates our members have worked so hard to pass in order to create a fair and consistent standard of prosthetic coverage could be eliminated or ignored.  We should not eradicate the states’ role in innovating care standards. 

▪ Coverage for People with Disabilities  

There is still a lot of work to be done around health care reform to figure out how to provide adequate coverage for people with disabilities will be covered.  Will they be included in the general exchange or in the separate category of coverage that is being discussed for people with health disparities?   This category currently looks at race, gender and ethnicity.     

Many people with disabilities may be pushed towards accessing Medicaid for coverage, which limits and employment prospects.  Additionally, the standards in Medicaid benefits vary from state to state in terms of what is covered.  This issue has been discussed, but there is no plan to address this within healthcare reform.  Baucus has indicated a willingness to look at this [Medicaid inconsistencies] at a later date.

It is not successful reform if the only option for people with disabilities is to go on Medicaid.  Congress also needs to look at updating Medicaid and creating more consistent standards. 

NEXT STEPS

The ACA is working to develop materials and talking points to conduct wide scale outreach to ACA members to raise awareness about current health care reform challenges specific to the ACA’s constituents.  We will also work to generate grassroots lobbying contacts to address these issues.