From lbrb - Left Brain Right Brain
By Matt Carey
February 24, 2017
One of the major goals of the new American government is the “repeal and replacement” of the Affordable Care Act (also known as ObamaCare). So far we haven’t seen a clear idea of what “replace” will mean.
Some features of the ACA have been very helpful to our communities: helping more people obtain healthcare insurance and eliminating the ability of insurance companies to deny coverage based on pre-existing conditions, to name but two.
NPR.org has an article that goes into some other questions about what could change: GOP Considers Trimming Health Law’s 10 Essential Benefits
Here are a few points that stand out:
The law requires that plans cover “rehabilitative and habilitative services and devices.” Many employer plans don’t include habilitative services, which help people with developmental disabilities such as cerebral palsy or autism maintain, learn or improve their functional skills, via speech or occupational therapy or other support services.
Federal officials issued a regulation that defined habilitative services and directed plans to set separate limits for the number of covered visits for rehabilitative and habilitative services.
Those rules could be changed.
“There is real room for weakening the requirements” for habilitative services, says Dania Palanker, an attorney and assistant research professor at Georgetown University’s Center on Health Insurance Reforms, who has reviewed the essential health benefits coverage requirements.
Occupational therapy and speech therapy are very common, especially among very young autistics.
Mental Health and Substance Use Disorder Services
The health law requires all individual and small group plans to cover mental health services and treatments for substance use disorders. In the regulations, the Obama administration said that means those services have to be provided at “parity” with medical and surgical services, meaning plans can’t be more restrictive with one type of coverage than the other regarding cost sharing, treatment and care management.
“They could back off of parity,” Palanker says.
Mental health parity is how other therapies for autism, including ABA, are funded.
Medicaid expansion is also a big target. Medicaid expansion is how health insurance was delivered to many people who could not afford it before.
Fewer people will be insured going forward. The position of at least one Republican (speaking today at CPAC) is that is a good thing. That means more people have exercised their choice. Unfortunately, that’s not the way things work for those in the disability community, where many are under- and un-employed. We are talking about people whose choice is to have healthcare insurance and who may not after the overhaul of the Affordable Care Act.
As an aside–medicaid also provides a lot of funding for services for people with disabilities. The government currently has committed to pay a set share of the costs of these services. There are plans to “block grant” medicaid, which is a way to limit the amount the government pays. If implemented this will reduce the quality of life for people with disabilities a great deal.
There are major changes possible that could affect people with disabilities. This is the time for parents of those who can not self-advocate to step up and be advocates. This is the time for self-advocates to self advocate.