In any effort at Healthcare Reform, there is a major issue to be addressed--parity in coverage for ALL conditions, diseases, and treatments, including mental health (which is a very big one). This diary focuses on parity for durable medical equipment, which includes prosthetic limbs for amputees.
Many Kossacks know that I am a partial leg amputee--the technical term is RBK or right BKA, which is a right below-knee amputee (or baloney amputee among friends--call me Oscar Mayer). Under our deteriorating insurance system, coverage for prosthetic limbs has become a significant hardship for thousands of amputees and their families.
More after the jump (OK, more of a stumble in my case)...
As you might detect from my perverse humor (and what about me isn't perverse?), I am somewhat atypical for an amputee. I'm a middle-aged man, stocky build, overweight, with a BK amputation. Going by statistics, I should be having more chronic problems than I actually do. Fortunately for me, I had an excellent surgeon and the best prosthetist in the region. Plus, on the one issue at least, I'm just damn lucky. I don't have chronic pain (phantom or real), recurring swelling or fit problems (usually a problem for my condition and body type), and I'm still on my first artificial leg after eight years (which is practically unheard of).
But most of my fellow amputees are not so fortunate. Add to that the fact that I had adequate insurance and a good job at the time, and I was really lucky. The rest of my life is a complete train wreck, but this portion, at least, has worked out far better than average.
What amputees and families face today:
All across America, families facing limb loss or a child born with limb differences have a tough time. Prosthetics coverage can be severely limited or even non-existent. According to the Amputee Coalition of America, our national advocacy group, only a handful of states mandate equal coverage for prosthetics (parity), and even then it only applies to intra-state employers (coverage for interstate employers is defined by ERISA, which preempts state regulations).
Here are some examples:
- Many policies set very low annual or lifetime maximums--mine was $2000 per year.
- Artificial limbs can range from several thousand to tens of thousands of dollars.
- New amputees typically need more than one socket as their stump shrinks in the first 6-24 months after amputation.
- Children with congenital or acquired limb differences need a series of limbs as they grow or wear them out.
- Active children and adults may need more than one limb for various activities.
- Many insurance plans arbitrarily set the minimum life of a limb at five years or similar--if it breaks and can't be repaired, the amputee is out of luck.
The harsh reality:
Many amputees and their families face financial hardship trying to get the limbs they need. Far too many amputees are forced to wear painful, ill-fitting, or damaged artificial limbs or even go without! As a result, many children and teens miss out on essential activities in their formative years. For adults, many of them with families to provide for, it may be difficult to pursue educational opportunities, function in daily life, or even hold a job. This means more stress on scarce social services which could be prevented by enabling people to be functional members of society.
These severe limitations in coverage are against our collective interest. Such practices are short-sighted, based on short-term corporate profits rather than what is best for people and society-as-a-whole. It's also more costly in the long run.
What we're doing:
Independent of the general healthcare reform effort, the Prosthetic & Custom Orthotic Act of 2009 (H.R.2575) was introduced in the House on May 21, 2009. The ACA is working with Senator Snowe’s office to get the bill introduced in the Senate as soon as possible.
The bill was originally introduced in the House, authored by Rep. Robert Andrews (D-NJ), with George Miller (D-CA), Todd Platts (R-PA), Mario Diaz-Balart (R-FL), and Lincoln Diaz-Balart (R-FL) signing on as original co-sponsors. In addition, Senators Olympia Snowe (R-ME), Tom Harkin (D-IA) Daniel Inouye (D-HI) and Russell Feingold (D-WI) introduced a prosthetic parity bill in the US Senate. Senators Bob Casey, Jr. (D-PA), Bernie Sanders (I-VT) and Patrick Leahy (D-VT) signed on as co-sponsors right before the Senate adjourned.
This July, the Consortium for Citizens with Disabilities (CCD), including ACA, wrote Sen. Edward M. Kennedy to thank him for getting the Affordable Health Choices Act successfully passed by the Health, Education, Labor and Pensions (HELP) Committee, of which he was the Chair.
This comprehensive health reform legislation represents a positive sea change that will significantly improve access to health and long term services and supports for people with disabilities and chronic conditions.
. . .
We believe that the goal of health care reform should be to assure that all Americans, including people with disabilities and chronic conditions, 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. This measure goes a long way toward meeting that goal.
. . .
Many of the provisions will greatly improve the lives of people with disabilities and chronic conditions. In particular, we strongly support the insurance market reforms, including guaranteed issue and renewal of coverage in the individual and small group markets, the prohibition of pre-existing health condition exclusions, and the end of annual and lifetime insurance caps with a limit on out of pocket spending.
. . .
This statutory language establishes coverage for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) which are critical to the disability and chronic illness population. The bill also covers as essential benefits rehabilitative, habilitative, and mental health and substance abuse services -- all of which are critical to enabling people with disabilities to function independently.
It is imperative that this language make it into the final bill. Without it, American's with amputations and limb differences will effectively be left behind.
How you can help:
Please share this information with your friends, post it on other progressive blogs and boards, and include it when you contact your Senators and Representatives. Prosthetic parity and other coverage for durable medical equipment and related supplies will make a tremendous difference for many American families. Please remember parity issues for all conditions and disabilities, including mental health, as well. Your fellow Americans need your support!
As the ACA says: "arms and legs are not a luxury". Please help to spread this important message.
UPDATE--Title changed from "HCR: Don't leave amputees behind" to "Healthcare Reform: Don't leave amputees behind" to "No Amputee Left Behind! (Healthcare Reform)".