Aca Advocacy


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Amputee Advocacy Action Around the Country

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Aca Advocacy

  1. 1. Amputee Coalition of America AOPA Policy Forum
  2. 2. Prosthetic and Orthotic Parity <ul><li>Prosthetic and Orthotic Parity at its core means that insurance companies cannot create special provisions and restrictions on care </li></ul><ul><li>The goal of these laws is to take prosthetics and customized orthotics out of the durable medical equipment category and treat these devices like any other benefit within the policy </li></ul><ul><li>19 states have passed prosthetic parity laws. Seven of those states were also able to include orthotic parity, and Maryland was able to include orthopedic braces </li></ul>
  3. 3. What Can You Do? <ul><li>Educate legislators at the state and federal level about key issues affecting this population </li></ul><ul><li>Work with the ACA, AOPA, and other advocates to develop and execute a strategic plan </li></ul><ul><li>Maintain contact with other advocates </li></ul><ul><li>Attend meetings and conference calls as needed </li></ul><ul><li>Travel to the capitol for hearings and votes </li></ul><ul><li>Reach out to support groups and patients about legislative issues and get them involved </li></ul>
  4. 4. How does this affect me? <ul><li>By getting involved in fighting for prosthetic and orthotic parity at the state level, you have the ability to give current and future amputees, and those in need of customized orthotics the chance to have access to affordable prosthetic and orthotic care </li></ul><ul><li>By passing legislation at the state level, legislators at the federal level are more likely to act. The more states that enact prosthetic and orthotic parity, the more likely it is we will be able to pass a law at the federal level to ensure everyone will have access to affordable coverage </li></ul><ul><li>With the support from individuals, business owners, and practitioners like you, legislators at both the state and federal level will begin to understand the needs of the limb loss community and will be in a better position to help make positive changes </li></ul>
  5. 5. What Do Legislators Want to Know? <ul><li>Background about you, your business, the process and care that goes into fitting each individual </li></ul><ul><li>How many amputees are in your state </li></ul><ul><li>What are the costs associated with a law like this to individuals </li></ul><ul><li>What are current restrictions on care </li></ul><ul><li>Have you had patients who have had difficulties getting access to care </li></ul>
  6. 6. Facts and Figures <ul><li>There are nearly two million Americans living with limb loss </li></ul><ul><li>It is estimated that there are 4.9 amputees per 1,000 members of the population </li></ul><ul><li>It is estimated that upwards of 40% of the limb loss population are over the age of 65 and use Medicare </li></ul><ul><li>This leaves 60% of the limb loss population to get access through their insurance plans, of which about 50% are regulated at the state level and 50% are regulated at the federal level, although this can vary greatly from state to state </li></ul>
  7. 7. Cost Studies: <ul><li>Department of Health Policy & Planning Report, Colorado found that, “the maximum increase in premiums would be about 12 cents PMPM. This cost estimate did not take into account that there would be a cost savings by both the private and the public sector.” </li></ul><ul><li>California’s analysis of AB 2012 stated that, “because these savings are less than 0.01% of total premiums in the small-group market, we assume that employers would not respond to such a small potential savings (by cutting off the insurance).” </li></ul><ul><li>Hewitt Associates LLC Trends in HR and Employee Benefits: Prosthetic Parity found “the average premium increase across all plans would be $0.16 PMPM. The average premium increase that employers would actually pay, according to the California Health Benefits Review Program, would be around $0.11 PMPM across all plans.” </li></ul><ul><li>Analysis of SB 931 (Virginia): Orthotic and Prosthetic Devices said “Estimates in Virginia were even lower [than other state studies] ; with PMPM impacts between $0.02 and $0.08.” </li></ul><ul><li>The Evaluation of Senate Bill 931, JLARC of Virginia’s General Assembly found that “amputees who have access to prosthetic devices show a reduction in the secondary conditions caused by increased sedentary lifestyle, have decreased dependence on caretakers, and a reduced chance of additional medical complications leading to further amputations.” </li></ul><ul><li>JLARC also found that “mandating coverage under SB 931 is not expected to increase the number of individuals seeking care through Virginia’s Medicaid program, and has the potential to reduce the number of individuals that may seek Medicaid coverage.” And that, “the proposed mandate is not expected to have a significant impact on overall healthcare costs in Virginia and may reduce total overall costs.” </li></ul>
  8. 8. Savings: <ul><li>Colorado legislature state study on providing prosthetic and orthotic care through Medicaid could expect savings of $448,666 per year due to a reduction in secondary complications </li></ul><ul><li>People are more likely to be active and contributing members of society </li></ul><ul><li>Several studies have shown that by spending $1 on rehabilitative care, you can expect to save up to $11 on disability benefits, including posthetic and orthotic care </li></ul>
  9. 9. Savings Continued: <ul><li>The incidence of diabetes-related complications is increasing. Medications for these conditions can cost up to $100 per month. If someone becomes an amputee at age 55 and lives to be 77, that’s $254,000. </li></ul><ul><li>If someone suffers a heart attack due to peripheral vascular disease, surgical treatment and hospitalization can cost from $75,000 to $200,000, depending on procedures used and the patient’s lifespan. </li></ul><ul><li>If a person develops knee or hip problems from being unable to walk correctly, resulting costs can range from $80,000 to $150,000 or more over a lifetime, depending on the care that is needed. </li></ul><ul><li>Crutch overuse can cause wrist, elbow and shoulder problems. The cost for a simple carpal tunnel wrist surgery averages about $7,500; elbow surgery averages $16,000, and shoulder surgery averages $25,000. </li></ul><ul><li>For every dollar spent on rehabilitation, including orthotic and prosthetic care, there is a savings of more than $11 in disability benefits. </li></ul>
  10. 10. Access to Care <ul><li>By providing access to prosthetic and orthotic care, studies have found that it can result in a reduction or elimination of costs associated with the following: </li></ul><ul><li>The secondary conditions that result from a sedentary lifestyle: </li></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Cardiovascular disease </li></ul></ul><ul><ul><li>Loss of muscle and bone mass </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Some forms of cancer </li></ul></ul><ul><li>The secondary conditions that result from wheelchair or crutch use: </li></ul><ul><ul><li>Orthopedic overuse of wrist, elbow, shoulder, foot, ankle, knee and hip joints among others </li></ul></ul>
  11. 11. States with Parity (19) <ul><li>Colorado (2001) </li></ul><ul><li>Maine (2003) </li></ul><ul><li>New Hampshire (2004) </li></ul><ul><li>California (2006) </li></ul><ul><li>Massachusetts (2006) </li></ul><ul><li>Rhode Island (2006) </li></ul><ul><li>Oregon (2007) </li></ul><ul><li>New Jersey (2008) </li></ul><ul><li>Indiana (2008) </li></ul><ul><li>Vermont (2008) </li></ul><ul><li>Louisiana (2008) </li></ul><ul><li>Arkansas (2009) </li></ul><ul><li>Virginia (2009) </li></ul><ul><li>Iowa (2009) </li></ul><ul><li>Maryland (2009) </li></ul><ul><li>Texas (2009) </li></ul><ul><li>Missouri (2009) </li></ul><ul><li>Illinois (2009) </li></ul><ul><li>Utah (2010) </li></ul>
  12. 12. Federal Initiatives <ul><li>The ACA and AOPA are working with partners at the Federal level to pass the Prosthetic and Customized Orthotic Parity Act </li></ul><ul><li>The bill has been introduced in both the House and Senate with bipartisan support </li></ul><ul><li>The House bill was introduced on 5/21/09 </li></ul><ul><li>The Senate bill was introduced on 4/19/10 </li></ul><ul><li>These bills would require that any insurance company that offers coverage for prosthetics and customized orthotics must provide them with terms that are no less favorable than other benefits within the individual’s policy </li></ul>
  13. 13. Meeting with Legislators <ul><li>Make an appointment with the legislator or their staff (staff are very important to legislators so do not be discouraged if you are meeting with a staff member) </li></ul><ul><li>Introduce yourself, give them your background information </li></ul><ul><li>State the legislation you’re interested in talking about and stay on topic (I’m here to talk about H.R. 2575 or S. 3223) </li></ul><ul><li>Provide some of the facts and figures available on the one pagers we have provided </li></ul><ul><li>Emphasize how this would impact their constituents (low cost, better quality of life, reduction in secondary costs and complications, good for business) </li></ul><ul><li>Ask what you can do, what other information they would like you to provide, and if they have any questions about the legislation </li></ul>
  14. 14. Other Ways to get Involved <ul><li>Letter to the editor drives </li></ul><ul><li>Get family, friends, and patients to sign petitions </li></ul><ul><li>Call into legislative offices on hearing and voting days or attend at the capitol building </li></ul><ul><li>Set up an in district meeting to discuss federal initiatives with your state Representative or Senator </li></ul><ul><li>Become a member of the ACA and share your contact information to stay informed and involved </li></ul>
  15. 15. Contact Information <ul><li>202-742-1885 </li></ul><ul><li>[email_address] </li></ul><ul><li> </li></ul><ul><ul><ul><li>Dan Ignaszewski </li></ul></ul></ul><ul><ul><ul><li>Government Relations Coordinator </li></ul></ul></ul><ul><ul><ul><li>Amputee Coalition of America </li></ul></ul></ul>
  16. 16. Questions?