Obamacare Presents Complex Choices for People with Disabilities

by Eric Whitney, CPR
Reprinted, in part, with permission by www.kaiserhealthnews.org.

The Affordable Care Act has set new standards – called essential health benefits  — outlining what health insurance companies must now cover. But there’s a catch: Insurance firms can still pick and choose to some degree which therapies they’ll cover within some categories of benefit. And the way insurers interpret the rules could turn out to be a big deal for people with disabilities who need ongoing therapy to improve their day-to-day lives.

Health economist Lisa Clemans-Cope with the Urban Institute says, “You’re much more likely to find these benefits in a plan in the individual market [starting in 2014] than you would be.” This is because habilitative services are included within the 10 categories of essential health benefits the ACA will require in those new plans. Still, while some categories are straightforward, such as maternity care and preventive care, the category including habilitative services leaves more room for interpretation. For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.

Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have therapies covered are going to have to slog through some fine print to figure out if they’ll actually benefit from a particular policy. (The new policies will start to go on sale this fall and go into effect beginning Jan. 1, 2014.)  This is a big improvement, but we should emphasize that it’s not totally fixed. And people are really going to have to get help to decide which plans cover the benefits they need, she said.

Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits insurers have to provide in each category is based on a model policy in each state, and some of those model policies are a lot more generous than others. Jill Tappert, an activist in Colorado for people with disabilities, says a lot of details still need to be sorted out before she’ll be able to say whether the health care law has improved things much.  I certainly hope the way the Affordable Care Act is implemented is a game changer for people in the disabilities community. It can be, says Tappert, who spent years fighting for habilitative service coverage for her daughter who has autism.  The opportunity is there for policy makers to vastly improve lives.

Last Updated 09/23/2020

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