On April 19, Senators Olympia Snowe (R-ME) and Tom Harkin (D-IA) introduced bill S.3223 in the U.S. Senate. According to a joint press release issued by the Amputee Coalition of American (ACA) and the American Orthotic & Prosthetic Association (AOPA), the introduction of this bipartisan bill, which is also known as the “Prosthetics and Custom Orthotics Parity Act of 2010,” is “a major step toward ensuring that Americans with disabilities have fair access to the mobility devices they need to support their families and live full, active lives. Such devices include artificial arms and legs for amputees and custom orthotic devices for people challenged by cerebral palsy, muscular dystrophy, multiple sclerosis, spina bifida, and other diseases.”
This legislation bans employers and insurers from imposing stricter limits on insurance coverage for prosthetic arms and legs and custom orthotic devices than those set for other essential medical care.
“Our legislation will ensure that group health plans treat coverage of such prosthetics and custom orthotics on par with other essential medical care covered by health insurance,” Snowe said. “Providing more meaningful coverage is particularly essential for children who may require more frequent replacements as they grow.”
“Hundreds of thousands of Americans living with limb loss are currently required by their insurance companies to pay out of pocket for prosthetic devices that are integral to their daily lives,” Harkin said. “While most insurance companies cover prosthetics and orthotics, there are many instances where the benefits are arbitrarily capped or exclusions are imposed on those who need them. This legislation will require insurance companies to provide the same benefits for prosthetic devices as they do for other treatments, helping individuals with disabilities more fully participate in school, work, and community activities.”
S.3223 will remove lifetime caps and exemptions that 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 have even eliminated coverage completely for artificial limbs, the ACA and AOPA said.
The importance of federal parity legislation has grown dramatically with the passage of the recent healthcare reform law, which permits health insurers to sell across state lines under “health insurance compacts,” AOPA Executive Director Thomas Fise noted. “These multi-state arrangements allow the insurer to select the lowest common regulatory denominator. It is feared that states without parity laws would often be the insurer’s regulatory venue of first choice. This choice would in effect rescind or override any parity laws that may have been passed in other states served by the health insurance compact. That makes this federal parity law virtually indispensable both in filling in the gaps created as to Employee Retirement Income Security Act (ERISA) plans that are unaffected by state laws as well as reinforcing existing state laws most crucial to preserve patient care that are not subject to lifetime limits or other arbitrary benefit caps.”
Legislation for fair prosthetic and orthotic coverage is also receiving support in the U.S. House of Representatives, in state legislatures around the country, and from many prominent leaders and organizations, the ACA and AOPA noted.
On May 21, 2009, a similar bipartisan bill, H.R. 2575, was introduced in the U.S. House of Representatives by Representative Robert E. Andrews (NJ-1). It was co-sponsored by Representatives Lincoln Diaz-Balart (FL-21), Al Green (TX-9), George Miller (CA-7), Todd Russell Platts (PA-19), and Joe Sestak (PA-7).
Additionally, almost 30 national healthcare associations-including such organizations as Paralyzed Veterans of America, the Christopher and Dana Reeve Foundation, Easter Seals and United Cerebral Palsy-have also signed on in support of parity legislation, the ACA and AOPA said.
“This momentum and widespread support from individual amputees and organizations, such as the American Orthotic & Prosthetic Association, help the Amputee Coalition of America continue to advance this legislation on Capitol Hill and in state legislatures throughout the country,” said Marshall J. Cohen, chairman of the ACA board.
