2010 Issue #8
HEALTH CARE REFORM'S IMPACT ON PERSONS WITH DISABILITIES
Health care reform is one of the most hotly debated issues this year. Congress included a lot of things in the bill that will impact people with disabilities and give states some much-needed help in rebalancing their long term care systems.
President Obama signed the Patient Protection and Affordable Care Act of 2010 into law in March. The new law expands health insurance coverage to 32 million uninsured Americans and strengthens existing insurance coverage.
But there is so much more in this nearly 2,000 page law. For instance, the bill makes significant changes that encourage home and community based services so that people with disabilities do not have to choose between living at home and getting the services they need.
Since many of these changes require states to take quick action in order to qualify for additional federal dollars, we thought it might be a good idea to highlight some of the important impacts this bill has on persons with disabilities. It is important to remember that these changes are now law, and that advice you give your elected officials should be about making these laws work for you and others with disabilities. Arguing over whether the law should have passed in the first place is not helpful to those who have the responsibility of putting it into place.
The following was developed from an excellent summary prepared jointly by National Spinal Cord Injury Association and American Association of People with Disabilities. You can see the entire review by clicking here.
HOME & COMMUNITY BASED SERVICES
Health care reform included several changes to expand home and community based services to help make it easier for people with disabilities and chronic conditions to live at home and participate in their communities.
- Community First Choice Option - Federal law has always required states to pay for institutional levels of care, and given them the “option” of providing home and community based services. Health Care Reform allows states to make home and community based services the “rule” rather than the “exception” for Medicaid-eligible individuals with disabilities with incomes up to 150% of the federal poverty level, if they would otherwise require institutional care. States that opt for this change will get an extra 6% added to their federal match. Effective October 1, 2011.
This is optional for states, so if you want Iowa to do this, contact your State Senator, State Representative, and the Governor.
- Money Follows the Person - Extends this popular demonstration grant program until September 2016. This program helps move people living in institutions to smaller settings in their communities or into their own homes. This is good news for Iowa, if we apply for the extension, as many of the people moved from institutions were to transition from grant-funded services to the resource-strapped county system in the coming years.
This is optional for states, so if you want Iowa to do this, contact your State Senator, State Representative, and the Governor.
- Medicaid Home & Community Based Services - Changes make it easier for state Medicaid programs to offer home and community based services by allowing states to amend their state plans, rather than go through the long Medicaid waiver process. This means changes that expand Medicaid home and community based services options may go into effect more quickly.
Iowa can now change and expand its HCBS waiver program quicker and more easily than before, so if you have changes to suggest, talk to your State Senator, State Representative and the Governor.
- Community-Living Assistance Services & Supports (CLASS) - establishes a national voluntary insurance program allowing people with functional limitations to receive benefits of not less than $50/day to pay for services and supports of their choice to help with daily living activities. To qualify, people will have had to pay premiums for at least five years. This voluntary long term care insurance program will help people remain independent, employed, and in their communities. Unlike Medicaid, CLASS does not require people to be impoverished to qualify for the program.
The federal government will be developing this, so contact you US Senators, US Representative, or the US Department of Health & Human Services.
PRIVATE INSURANCE CHANGES
- Pre-Existing Conditions - Ends insurance discrimination against people due to disability or other pre-existing condition. Insurers can no longer deny coverage, charge higher premiums or exclude benefits because of pre-existing conditions or disability. This is effective for children in September 2010, and adults by 2014.
This will automatically go into effect in 2010 and 2014, and is a federal issue that you should discuss with your US Senators and US Representative.
- Lifetime Limits & Annual Caps - Eliminates lifetime caps on insurance immediately. Most insurance plans have a lifetime cap of $1 million, and people with disabilities or chronic conditions often exhaust these caps quickly. Annual caps are eliminated by 2014.
This will automatically go into effect in 2010 and 2014, and is a federal issue that you should discuss with your US Senators and US Representative.
- High Risk Pools - Makes high-risk pools available temporarily to cover persons with pre-existing conditions that have been without insurance for at least six months. This is a temporary option to help people with pre-existing conditions get coverage immediately, until all insurance reforms are in place in 2014. These temporary pools will still be an expensive option for many Iowans. Iowa has chosen to expand its existing pool, but state officials say there is probably only funding for about 1,200 people to be added between now and 2014.
Iowa’s Insurance Commissioner is working on this now, so contact your State Senator, State Representative, the Governor, and the Insurance Commissioner if you have suggestions or want to know
more.
- Essential Benefits - Establishes a basic level of coverage that all insurance plans will have to pay for by 2014. These benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including dental and vision care.
The addition of the two highlighted benefits is a big benefit to people with disabilities.
Many people with disabilities consider these options to be essential services, but pre-health care reform insurance policies did not cover them or severely limited the number of treatments and the types of disability/illness covered. Rehabilitative and habilitative services often are needed to maintain muscle strength and flexibility, as well as eliminate or lower the number of spasms. Full mental health parity has been a challenge in many states, including Iowa. This change will make sure that all insurance plans cover treatment for the full range of mental health and substance use disorders.
“Devices” are meant to include all durable medical equipment (including wheelchairs), prosthetics, orthotics and supplies (DMEPOS). Many disability groups are advocating for the Department of Health and Human Services to explicitly state that DMEPOS will be covered, to take out any misunderstanding the insurance industry might have in implementing this reform.
The US Department of Health & Human Services (HHS) can add to this list before everything goes into effect, and they were asked to specifically take into account the health care needs of people with
disabilities when developing the final minimum benefits list. Contact your US Senators, US
Representative, and the HHS if you have comments, concerns, or suggestions about this.
- Cost Sharing Limits - Limits what people will have to pay out-of-pocket to those placed on health savings accounts. Small employer plans cannot have deductibles greater than $2,000 for individuals and $4,000 for families.
This will automatically go into effect and is a federal issue that you should discuss with your US Senators and US Representative.
MEDICARE & MEDICAID CHANGES
- Expansion of People Eligible for Medicaid - Increases the number of people who are eligible for Medicaid. Since many people with disabilities have low or very modest incomes, this Medicaid expansion will give many more people with disabilities the right to health care coverage. In 2014, adults with incomes up to 133% of the federal poverty level will be eligible for Medicaid (right now you have to either have a disability or a child in order to be eligible for Medicaid). Families with incomes up to 133% of the federal poverty level are also eligible for Medicaid, and the Early, Periodic, Screening, Diagnosis & Treatment (EPSDT) program is extended to all children on Medicaid, including those in managed care. EPSDT services address developmental disabilities and delays. States will receive an increased federal match for a few years. In 2009, the federal poverty level for individuals was $14,404 and for a family of four was $29,327. Between now and 2014, states have the option of expanding this coverage. In 2014, it becomes a requirement. States are required to maintain their current Medicaid services, and develop incentives to cover preventive services and immunizations without cost-sharing to adults under Medicaid.
If you want Iowa to expand Medicaid to these groups sooner than 2014, contact your State Senator, State Representative, and the Governor.
- Medicare Two-Year Waiting Period - Under existing law, people found eligible to receive disability benefits under Social Security’s SSDI and other Title II programs must wait two years before they can receive Medicare benefits. In the meantime, many people with disabilities go without needed health care, which often makes the disability worse and in some cases leads to death. While health care reform does not directly address this problem, some people may find temporary coverage with the high risk pool or through the health insurance exchanges once they go into effect (which cannot discriminate on the basis of pre-existing conditions) or they may qualify for Medicaid under its extended eligibility standards.
If you want to eliminate this two-year waiting period entirely, contact your US Senators and US Representative.
- Medicare Part D Gap in Prescription Drug Coverage - Phases out the famous “donut hole” (gap) in prescription drug coverage under Medicare by 2020. Currently, when Medicare enrollees are in the donut hole (after they reach a certain limit on prescription drug coverage and before additional coverage kicks in), they must pay for prescription drugs at full price. Health care reform provides a one-time $250 rebate for prescription drugs after enrollees enter the donut hole in 2010. Beginning January 1, 2011, it provides a 50 percent discount on brand name drugs and other discounts for generic drugs for enrollees in the donut hole.
This will automatically go into effect and is a federal issue that you should discuss with your US Senators and US Representative.
- Medicare Outpatient Therapy Caps - Extends some exceptions to caps on Medicare Outpatient Part B Therapy Services, thus allowing Medicare enrollees to get medically necessary therapy services beyond the $1,860 cap for occupational therapy, and $1,860 cap for physical therapy and speech-language pathology services. This extension goes until December 31, 2010.
If you want these exceptions extended for a longer period of time, you should discuss this with your US Senators and US Representative.
- Elimination of Medicare First-Month Purchase Option for Power Wheelchairs - Under existing law, Medicare beneficiaries have the option to purchase their power wheelchairs, rather than rent them. This enables the person with long-term need of a wheelchair to have it adjusted to his or her size and unique needs. Under health care reform, Medicare will only pay for rental, rather than purchase, of certain power wheelchairs for the first thirteen months of use (with exceptions for certain classes of complex rehab power wheelchairs). During the 13-month rental period Medicare will pay 80% and the beneficiary will pay 20% of the rental cost.
Many disability groups are concerned with this change because wheelchairs are not all created equal. They require many adjustments to meet the individual user’s size and needs. With purchased wheelchairs, suppliers are likely to bear the cost of individualization, but they are not likely to do so for a rental that can be so easily returned. Without individualization, users frequently see conditions get worse or develop additional conditions that require treatment and often hospitalization, thus offsetting any cost savings to Medicare.
This is a federal issue that you should discuss with your US Senators and US Representative.
- Medicare Durable Medical Equipment Competitive Bidding Program - Existing law requires the US Department of Health & Human Services to implement a competitive bidding program for suppliers of wheelchairs and other durable medical equipment, under Medicare, as a cost-savings measure. Wherever competitive bidding goes into effect, Medicare will only pay suppliers selected by the department. Under current law, it is likely that there will be far fewer suppliers to choose from for both purchase and repairs of wheelchairs and other durable medical equipment and that the quality of products and repairs may go down. People who use wheelchairs may well have to give up their existing suppliers and find it difficult to get to the new suppliers for repairs. Health care reform speeds up the pace of expanding competitive bidding to and requires coverage of all areas by 2016.
This is a federal issue that you should discuss with your US Senators and US Representative.
- Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan - Requires Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, body-mass index measurement, and other screenings and risk factors.
This will automatically go into effect and is a federal issue that you should discuss with your US Senators and US Representative.
- Medicare Coverage of Anti-seizure, Anti-spasm, and Smoking Cessation Medications - Requires coverage of barbiturates, benzodiazepines, and tobacco cessation products under Medicare Part D. Barbiturates include phenobarbital and other medications that treat seizures. Benzodiazepines include sedatives, anti-anxiety medications, and anti-spasm medications. Both of these categories of medications were excluded from coverage under Medicare Part D.
This will automatically go into effect and is a federal issue that you should discuss with your US Senators and US Representative.
OTHER IMPORTANT CHANGES
- Community Health Center Funding - Adds $11 billion of funding for the nearly 12,000 community health centers around the country (there are 20 locations in Iowa). Community health centers are major providers of health care to people who are uninsured or underinsured, and are required to serve people regardless of their ability to pay.
This is a federal issue that you should discuss with your US Senators and US Representative.
- Accessible Medical Diagnostic Equipment - Requires the U.S. Access Board, in consultation with the Food and Drug Administration, to establish regulatory standards setting the minimum technical criteria for medical diagnostic equipment for people with disabilities. While existing law requires medical equipment to be accessible, these standards are intended to clarify how to comply with this requirement. These standards, to be completed in two years, will clarify minimum technical criteria for medical equipment in doctors’ offices and other medical facilities to be considered accessible for people with disabilities including people who use wheelchairs. The standards must make sure the equipment is accessible to, and usable by, individuals with accessibility needs, and must allow independent entry to, use of, and exit from the equipment by such individuals to the maximum extent possible. At a minimum medical diagnostic equipment covered by the new standards will include: examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals.
If you would like to weigh in on this discussion, contact the FDA, US Access Board, and your US Senators and US Representatives.
- Durable Medical Equipment Excise Tax - A new excise tax ($20 billion over 10 years) on medical devices will be imposed on manufacturers of medical equipment. It is intended to help offset the costs of health reform. Although the tax is imposed on manufacturers, the consumer will ultimately bear the cost because manufacturers are likely to pass these costs on to consumers through increased prices.
This will automatically go into effect and is a federal issue that you should discuss with your US Senators and US Representative.
- Training of Future Health Practitioners - Requires medical professionals to receive disability awareness training to help reduce the health disparities that exist for people with disabilities. Grants and other incentives are available to develop programs and model curricula to train health professionals and increase the number of health professionals (including dentists) trained to meet the health care needs of individuals with disabilities.
The US Department of Health & Human Services will be working on rules for this training, so contact them and your US Senators and US Representative if you have comments or suggestions.
- Nondiscrimination - Prohibits discrimination based on disability under any health program or activity which receives federal assistance, including credits, subsidies, or contracts of insurance. Look for the US Department of Health & Human Services to put out rules on this sometime in the coming months and years.
The US Department of Health & Human Services will be working on rules for this training, so contact them and your US Senators and US Representative if you have comments or suggestions.
- Comprehensive Workplace Wellness Programs - Makes grants available to eligible small businesses who give their employees access to comprehensive workplace wellness programs that meet criteria to be developed by the US Department on Health & Human Services. Employee wellness programs can be a good way to encourage better health. However, this provision could inadvertently have a negative impact on people with disabilities. For example, a person with a disability may be unable to participate in an exercise program or another benchmark of the wellness program. If employees who do participate receive a reduced deductible under the employer-sponsored health plan (or another financial incentive), the person with a disability who is unable to participate would end up paying a higher deductible (or would not be eligible for other financial incentive). To avoid inadvertent negative impacts on people with disabilities and chronic conditions, many disability organizations are working with the federal department to address this issue.
Contact your US Senators and US Representative, and the Department of Health & Human Services, if you have comments or suggestions.
- Data Collection and Analysis to Understand and Address Health Disparities - Requires the federal government to collect health survey data from people with disabilities to enable better understanding of the health of people with disabilities compared to other minority groups. The government is also required to collect survey data from health care providers in order to learn where people with disabilities receive their care, the number of providers with accessible facilities and equipment, and the number of health care professionals trained in meeting the health care needs of patients with disabilities. The new law also requires the development of recommendations for quality measures to improve health care for individuals with disabilities.
Contact your US Senators and US Representative, and the Department of Health & Human Services, if you have comments or suggestions.
The enactment of national health care reform is only the beginning. Advocates with disabilities and others will need to stay involved and offer their opinions and ideas as these changes are implemented and rules are changed. Iowans with disabilities need to work hard to make their voices heard, because the business and insurance communities are working just as hard to make theirs heard.
HEALTH CARE REFORM RESOURCES & CONTACTS
If you want to know more about health reform, here are a few resources. These are all very simple and easy to use, and provide you with excellent non-partisan and unbiased information.
If you know of more resources, let us and our other readers know by posting it on our infoNET Facebook page.
CONTACTS
US Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free Phone: (877) 696-6775
Email: Healthreform@hhs.gov
Discuss on Facebook:http://www.facebook.com/WhiteHouse
Sign-Up for Health Reform Updates here.
Iowa Insurance Commissioner Susan Voss
330 Maple Street
Des Moines, Iowa 50319-0065
Phone: (515) 281-5705
Toll free Phone: (877) 955-1212
Fax: (515) 281-3059
Email: http://www.iid.state.ia.us/contact_us/contactus.asp
Website: http://www.iid.state.ia.us/
Contacts for your US Senators, US Representative, State Senator, and State Representative can be found online at: http://www.legis.state.ia.us/FindLeg/.
BRAILLE & SIGHT SAVING INTERIM MEETS
The Board of Regents Legislative Study Committee on Residential Services on the Campus of the Iowa Braille and Sight Saving School has met three times over the last two months, and has begun the process of developing recommendations. This year, the Iowa Legislature (SF 2385) directed the Board of Regents to examine possible changes to the current structure for providing residential services on the campus of the Braille and Sight Saving School. Providers, families, advocates and others with a stake in this discussion were included on the work group.
If you are interested in this discussion, you can find out more online:
Study Group Agendas, Minutes & Materials are available by clicking here.
Background information is available by clicking here.
IOWA BEGINS HEALTH REFORM PLANNING
The Legislative Health Care Coverage Commission, and its three work groups, continues to meet monthly to coordinate Iowa’s responses to health care reform, and find ways to build on the reforms Iowa has already made to its health care system. The three work groups include:
There is much being discussed here, far too much to list in this issue. However, we do want to let you know where you can find out more information if you are interested in health care reform. All meetings are open to the public (although the public can only speak if invited to do so by a member of the work group or commission).
Cick here to view the Meeting Calendar.
Click here for information on the Commission.
Click here for information on Work Group 1.
Click here for information on Work Group 2.
Click here for information on Work Group 3.
Most materials reviewed by the groups can be found under “Additional Information.” Just click on the “Additional Information” link on the Commission or Work Group website, and you will find agendas, minutes, and materials handed out to members.
BRAIN INJURIES AMONG VETERANS ON THE RISE
Lawmakers have been hearing stories about veterans returning to Iowa with service-related traumatic brain injuries and psychological health conditions. These stories prompted the Iowa Legislature to expand the state’s limited mental health parity law to require insurance coverage for any mental illness diagnosed in a veteran (not just those illnesses that are “biologically based”).
The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury estimate that of the nearly 2 million Americans deployed to Iraq and Afghanistan, about 31% have experienced some psychological health condition or traumatic brain injury.
If this issue is important to you, make sure to ask your legislator how they voted (and either thank them for their vote, or educate them on why they should have voted differently).
THE POLITICAL CORNER
There were a few surprises on Primary Election night (June 8). State Senator David Hartsuch, an emergency room doctor representing the Davenport/Bettendorf area since 2007, lost to Davenport businessman Roby Smith by 174 votes. You can read more about Roby Smith by clicking here.
Smith will face Democrat Richard Clewell, a Davenport school board member and retired wildlife biologist, in the November General Election. Clewell beat Dave Thede, husband of State Representative Phyllis Thede, by 119 votes to become the Democratic candidate in this race. You can read more about Richard Clewell by clicking here.
State Representative Kerry Burt of Waterloo dropped out of his re-election in April, after criminal charges had been filed against him for tampering with records that allowed his children to attend the state-run Price Laboratory School at the University of Northern Iowa (saving him about $37,000 in tuition). Eight other families have also been charged.
Taking his place as the Democratic Candidate for House District 21 is 32-year-old Anesa Kajtazovic, a 23-year-old Bosnian immigrant whose family came to the Waterloo/Cedar Falls area in 1997. She is a UNI graduate and currently works as a mortgage analyst at GMAC. You can find out more about Anesa by clicking here.
Kajtazovic will face off against 64-year-old Republican John Rooff, the former five-term Mayor of Waterloo. In an odd twist, Rooff is also from a family of Eastern European immigrants. His grandfather left his native Bulgaria at 17, where his great-grandfather was a mayor. Both Rooff and his father were Waterloo mayors. You can read more about Rooff by clicking here.
A handful of current State Representatives faced primary challenges (Ako Abdul-Samad, Mary Gaskill, Chuck Isenhart, Dave Jacoby, Henry Rayhons & Jim Van Engelenhoven). All easily beat their opponents (but they still have to win the General Election on November 2 to continue serving their areas).
State Representative Paul Bell lost his fight with stomach cancer this month, dying at the age of 59. He was a retired police officer and represented the Marshalltown area since 1993, serving as the Chair of the House Natural Resources Committee. Rep. Bell, who had his stomach removed last year when the cancer first surfaced, didn’t miss a single day at the State Capitol this year, despite having chemotherapy and radiation treatment. Rep. Bell had planned to run again, and was unopposed. The Marshall County Democratic Central Committee will need to choose a new candidate for House District 41, and the Marshall County Republican Party may choose to do the same. Rep. Bell is survived by his wife Niki and two children.
On a much lighter note, Iowa is on track to keep its first-in-the-nation presidential caucuses, to be held January/February 2012. The Republican National Committee and Democratic National Committee both agreed to keep the Iowa Caucuses at the top of the Presidential line-up, with New Hampshire’s primary following in the days after.
Iowa is one of five states who have an Ex-Governor running for Governor again. Of course here in Iowa, former Governor Terry Branstad will challenge Governor Chet Culver in the November 3 election. Other states with ex-Governors running again are: California (Jerry Brown), Georgia (Roy Barnes), Maryland (Robert Ehrlich), and Oregon (John Kitzhaber). Brown and Kitzhaber are Democrats, the rest are Republicans.
Finally, the news about the state’s budget is improving. The Legislative Services Agency announced this month that the state’s budget continues to improve, but tax receipts are still down about 4.6% (or $211.6 million) from this time last year. That is a lot better than what was expected. Legislators built their budget around an 8.7% decline. If the year continues like this, the state can expect to have an extra $186.1 million at the end of the year. But don’t get too excited - the state still must address the nearly $500 million in one-time funds used to balance the budget this year, and uncertainty about cuts the federal government will pass on to states. You can see details by clicking here.
ELECTION RESULTS
You can find out who won the primary elections in your area, and the names of the candidates by clicking here.
If you do not know which district you live in - click here to find out.
You can find contact information for the candidates by clicking here.
All of this information will also be available on our Campaigns & Voting page.
MARK YOUR CALENDAR!
Advocating Change Day is back in 2011 - mark your calendars and plan on attending Advocating Change Day 2011 at the State Capitol in Des Moines on Wednesday, March 30, 2011. Details will follow later in the year.
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