60 Rehabilitation and Disability Organizations Host Successful Congressional Briefing

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By Peter W. Thomas, JD, and Jill O’Brien

On June 27, a group of rehabilitation and disability advocacy organizations, including the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), raised their voices on Capitol Hill with a single and powerful message:

Any version of health reform that emerges from Congress must preserve and protect access to rehabilitation and habilitation services and devices so that individuals with injuries, illnesses, disabilities, and chronic conditions can regain and/or maintain their maximum level of health and independent function.

Sen. Tammy Duckworth (D-IL) discusses the value of rehabilitative and habilitative services and devices.

Photograph by Leif Brierley.



The Coalition to Preserve Rehabilitation (CPR), the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, and the Habilitation Benefits (HAB) Coalition hosted a bipartisan and bicameral congressional briefing on the value of rehabilitation and habilitation services and devices in America's healthcare system. Sixty organizations within the coalition participated in the event, including NAAOP. (For more information about the briefing, including highlight clips from each speaker and a video of the entire briefing, visit the briefing page
on the CPR website at https://preserverehab.org/advocacy/congressionalbriefing.)

As a fitting backdrop for the event, Senate Majority Leader Mitch McConnell (R-KY) was in the process of attempting to bring his Better Care Reconciliation Act (BCRA) of 2017 to a floor vote that same day. However, shortly after the briefing, he was forced to postpone the vote, citing a lack of support.(Author's note: On July 28, shortly before publication of this article, the Senate was unable to achieve the votes necessary to replace the Affordable Care Act (ACA), and the bill was pulled from consideration on the Senate floor.)

During the briefing, Senator Tammy Duckworth (D-IL), an Iraq War veteran, Purple Heart recipient, and former assistant secretary of the Department of Veterans Affairs who has bilateral lower-limb amputations, and Representative Glenn Thompson (R-PA), a former rehabilitation therapist, addressed a packed hearing room of more than 200 congressional staffers, advocates, rehabilitation professionals, and members of the public in the Dirksen Senate Office Building. Duckworth and Thompson were joined by panelists Roseann Sdoia, a Boston Marathon bombing survivor who uses a prosthesis, Eric LeGrand, a former Rutgers University football player who sustained a spinal cord injury during a game, Lisa Smith, the mother of a recipient of habilitation services, and Gregory J. O'Shanick, MD, president and medical director at the Center for Neurorehabilitation Services, Richmond, Virginia. Peter W. Thomas, JD, coordinator of the three coalitions that hosted the briefing and user of bilateral lower-limb prostheses, performed the role of master of ceremonies.

Panelists spoke passionately about their experiences accessing, using, and paying for rehabilitative services and devices. As a wounded warrior, Duckworth recalled having access to state-of-the-art prostheses and rehabilitative care, including the Ottobock C-Leg. She sustained amputations when the Blackhawk helicopter she was piloting was shot down during the Iraq War in 2004, before the passage of the ACA and the Patient Protection Act. Duckworth remembered meeting other people with limb loss across the country who could not afford or access the types of prostheses she received because they did not have the same high-quality healthcare coverage.

"I realized how different the world was for people who have access to the care that they need, and those—who are the majority of Americans—who don't; and that's not right," she said. Duckworth told of having people with amputations approach her in airports in awe of her C-Leg, and asking to touch it since that was as close to one as they were likely to get due to its cost.

In addition to the speakers' powerful testimonials about the value of rehabilitation and habilitation services and devices, the briefing also featured demonstrations of assistive devices and technologies. Attendees could learn how the technologies work and discuss their value with users of the devices. For instance, the president of NAAOP's board of directors, David McGill, who has a transfemoral amputation, demonstrated the Össur POWER Knee, and Maggie Baumer, an NAAOP board member, demonstrated an Ottobock bebionic prosthetic hand. Another user demonstrated how the EksoGT wearable exoskeleton assists those with spinal cord injury and stroke. Other featured assistive devices and technologies included complex rehab technology wheelchairs, a cochlear implant to address hearing loss, and a speech generation device.

The three coalitions who hosted the briefing, CPR, the HAB Coalition, and the ITEM Coalition, started planning the Hill day and congressional briefing earlier this year, when it became clear that major protections in the ACA might be jeopardized through efforts to repeal and replace the ACA.

NAAOP was one of 18 organizations to sponsor the briefing, contributing funds to cover the cost of promotional materials, travel expenses for speakers, catering, video and livestream coverage, and sign language interpreters. Forty-two other organizations, including the Amputee Coalition, the American Heart Association, United Spinal, therapy organizations, the Multiple Sclerosis Society, the Brain Injury Association of America, and many other organizations endorsed the briefing. (Editor's note: Visit https://preserverehab.org/advocacy/congressionalbriefing to view the full list of the sponsoring and endorsing organizations.)

To amplify the impact of the day's events, members of CPR and the HAB and ITEM Coalitions, alongside members of the Washington DC-based healthcare, education, and government relations law firm Powers Pyles Sutter & Verville, attended 50 Capitol Hill visits with Senate healthcare staff, a total of 30 Democratic senators' offices and 20 Republican senators' offices. At the Hill visits, attendees shared their personal stories of accessing rehabilitative and habilitative services and devices and encouraged members of Congress to protect access to these services as the congressional debate on healthcare reform continues.

While McConnell's decision to delay a healthcare vote until after the July 4 recess marked a small victory in efforts to preserve access to habilitative and rehabilitative care, congressional efforts to repeal and replace the ACA continued throughout July. At the time of this writing, the Senate was not able to achieve a majority vote on any version of ACA repeal, and therefore, the legislative effort to repeal or reform the ACA is stalled. Both the House Draft—the American Health Care Act, which passed by a slim majority on May 4, and the main Senate Bill—the Better Care Reconciliation Act of 2017, pose serious threats to access to rehabilitative and habilitative services and devices.

Both pieces of legislation, as well as several amendments to the Senate bill, would erode the essential health benefits (EHB) package established by the ACA, which require Medicaid expansion plans as well as individual and small group plans to cover certain health benefits, including rehabilitative and habilitative services and devices. Coverage of this benefit category encompasses coverage of orthotics and prosthetics. Erosion of the federal standard for rehabilitation coverage would be a huge loss for O&P consumers and the providers who serve them.

In addition, both the House and Senate bills propose significant changes to the Medicaid program under the ACA, including transforming the financing system for Medicaid from an entitlement program to a "per capita cap" model. This would effectively reduce federal financing for the Medicaid program by $700-$800 billion over the next ten years. Cuts and caps to Medicaid may further limit access to orthotics and prosthetics in many cases because states may not receive the level of federal Medicaid dollars required to meet the needs of beneficiaries.

Multiple speakers at the briefing stressed that access to rehabilitative and habilitative services and devices is necessary to provide every American with high-quality, effective, and humane care. "When we save a life, we do so with the intent to have that life be one of quality and dignity," said O'Shanick. "Rehabilitative and habilitative services and devices are a continuation of the contract we make as physicians when we save the life of the person in the emergency room," he said. "Rehabilitation allows us to finish the job for patients."

CPR, the HAB and ITEM Coalitions, and NAAOP will continue to advocate for the preservation of access to rehabilitative and habilitative services and devices, including orthotics and prosthetics, in the American healthcare system as Congress and the U.S. Department of Health and Human Services continue to consider reform of the ACA. 

Peter W. Thomas, JD, is general counsel for the National Association for the Advancement of Orthotics and Prosthetics (NAAOP).

Jill O'Brien is a health policy intern at Powers Pyles Sutter & Verville.