The health reform package recently signed into law by President Obama promises to be a game-changer for people with disabilities. We celebrate the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, and we applaud landmark market reforms that include non-discrimination, subsidies, and coverage expansion. At the same time, the job of health care reform has only just begun. An extensive regulatory and implementation process lies ahead that will require intense participation by disability rights advocates to ensure that the law fulfills its broad promise, eliminates health care inequalities, and results in the services, benefits, and programs that are critical to people with disabilities.
This issue of the DREDF eNews highlights seven disability-specific provisions of the new law that represent significant victories for the disability community. We also present several problem areas that bear watching, and provide links to summaries, timetables, and guides.
Disability is identified as a bona fide health disparity demographic for research and data collection. Read the Agency for Health Research and Quality's (AHRQ) 2009 National Healthcare Disparities Report.
Community Living Assistance Services and Supports (CLASS), a new, long-term care insurance program, will provide flexible benefits.
The Community First Choice Option brings people with disabilities one step closer to community-based services in their own homes.
The Access Board is directed to develop new access standards for medical diagnostic equipment.
By 2012, federally conducted or supported health care or public health programs must collect data on beneficiaries' disability status; survey health care providers in order to assess how many offer accessible facilities and equipment; and survey the number of employees of health care providers trained in disability awareness and patient care. Read Title XXXI of the Patient Protection and Affordable Care Act.
The law establishes funding for hospitals, and schools of medicine and dentistry, to develop educational curricula on disability competency. Read Title V and Subtitle D of the Patient Protection and Affordable Care Act.
Comparative effectiveness research, which will eventually influence treatments insurers will cover, will take into account potential differences in the effectiveness of healthcare treatments and services for people with various disabilities, their quality of life preferences, and also include representatives from these groups in research.
Disability-specific problem areas
The new law calls for insurance coverage of rehabilitation, habilitation, and devices. As the regulatory process unfolds, we must ensure that the word "devices" explicitly includes durable medical equipment, prosthetics, orthotics, and supplies.
An emphasis on health promotion that ties participation in wellness and prevention activities to lower premiums, rebates, co-payments, and deductibles could result in inequitable and substantial health care costs for some people with disabilities who cannot participate for reasons related to their disability or pre-existing condition. The law calls for alternative standards and waivers if participation is medically inadvisable or difficult due to medical conditions, and insurers may not use the provision as a subterfuge for discrimination. However, without strong clarifying regulations, the effect may be to undermine the sweeping prohibition against denial of coverage based on pre-existing conditions.
Read Congressman George Miller's (D-CA) floor statement on these issues.
Summaries, Timetables, and Guides
The Impact of Health Care Reform on People with Disabilities by United Spinal Association and the National Spinal Cord Injury Association
An Overview of Health Care Reform — A Power Point presentation developed by The ARC, UCP, AAIDD, AUCD and others
Summary of New Health Reform Law and Implementation Timeline by the Henry J. Kaiser Family Foundation
Get the Facts: Health Reform and Medicare, March 2010 and Health Reform and Medicare: A Timeline of Implementation by the Medicare Rights Center.
AARP—A User's Guide to Healthcare Reform
Recent Administration and Federal Agency Actions
"After Health Care Passage, Obama Pushes to Get It Rolling"
CMS Letter Explains New State Medicaid Option to Cover Low-Income Adults. The letter is one of a series to provide guidance on implementation of the new law.
"HHS Secretary Kathleen Sebelius Urges WellPoint to Immediately Stop Dropping Coverage for Women with Breast Cancer"