United States Representative Robert E. Andrews (D-NJ) has introduced the Prosthetic and Custom Orthotic Parity Act of 2009 to the U.S. House of Representatives, a bill that the Amputee Coalition of America (ACA) hails as “a great step toward ensuring that Americans with disabilities have equal access to mobility devices, such as artificial arms and legs for amputees and custom orthotic devices for people challenged by such diseases as cerebral palsy, muscular dystrophy, and multiple sclerosis.” The bill, H.R. 2575, recognizes the importance of mobility to overall health and bans employers and insurers from imposing stricter limits on coverage for prosthetic arms and legs and custom orthotics than those set for other essential medical care.
The bipartisan legislation was introduced May 21 and was co-sponsored by representatives Lincoln Diaz-Balart (R-FL), Al Green (D-TX), George Miller (D-CA), Todd Russell Platts (R-PA), and Joe Sestak (D-PA).
“At a time when healthcare costs are rising by about 7 percent annually, the financial hardship on those in need of prosthetic devices is devastating,” said Andrews. “Yet, by expanding coverage for prosthetic devices so that it is on par with other types of essential care, not only will amputees receive necessary treatment and experience better quality of life, but the healthcare industry as a whole will save money. Since prosthetics often dramatically decrease secondary health problems for those in need, the benefits of this coverage far outweigh the costs in the long run.”
Andrews also urged his colleagues to support H.R. 2575, saying that it will help end the inequity many Americans who have lost a limb or who live with cerebral palsy experience when their insurance company denies them coverage.
H.R. 2575 will remove lifetime caps and exemptions insurance companies often place on prosthetic and orthotic care, which reduce benefits to such a level that the average person can’t afford a prosthesis or complex bracing device. In some cases, these companies even eliminate coverage completely for artificial limbs.
“Such limits are unrealistic,” explained Kendra Calhoun, president and CEO of the ACA, “since an adult amputee will need a replacement prosthesis every five years and children even more frequently as they grow. It is absurd to expect amputees to use only one prosthesis in their lifetime. No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different. People pay their monthly health insurance premiums and expect their coverage to take care of catastrophic situations. Arms and legs are not luxuries.”
Legislation for meaningful prosthetic and orthotic coverage is also receiving widespread support from other leaders and organizations. In addition to the ACA, almost 30 national healthcare associations have signed on in support of federal parity legislation, including such prominent organizations as the American Diabetes Association, the Christopher and Dana Reeve Foundation, Easter Seals, and United Cerebral Palsy.
Prosthetic parity is also the focus of legislation at the state level. Since 2006, the ACA, working with amputee volunteers across the country, has supported initiatives resulting in 17 states passing prosthetic parity laws.
“This momentum and widespread support from individual amputees and organizations such as the American Orthotic and Prosthetic Association continues to advance this legislation in other state legislatures throughout the country,” said Calhoun.
The ACA has collected and analyzed data demonstrating that health insurance parity laws would have a minimal cost impact on insurance premiums-only about 12 to 35 cents per member per month.
“Passing H.R. 2575 would also prevent cost shifting for prosthetic care from health insurance companies to government programs such as Medicare and Medicaid,” said Calhoun. “This bill will return people to work and help them reclaim their lives at no cost to taxpayers.”