ACA: Closing a Loophole in the ADA

For Americans with disabilities, the Affordable Care Act promises to be the greatest civil rights advance in the last twenty years.

I just read some remarks by Kathleen Sebelius, Secretary of Health and Human Services, that she gave to the Interagency Autism Coordinating Committee a couple of days ago.  This committee was created as part of an overall federal strategy to address autism and “create new opportunities for those living with autism and their families to reach their full potential.”

While discussing the many initiatives that have been launched to address this goal, she also mentioned the effect of the Affordable Care Act (ACA).  She said:

“Now, thanks to the law, insurers can no longer deny coverage to children with pre-existing      conditions like autism and new plans must cover autism screening for children at no cost to parents.  The law will also ease the financial burden on treatment and care for people living with autism by allowing young adults to stay on their parent’s coverage until age 26 and putting an end to lifetime dollar limits on care.”

This observation by Secretary Sebelius could apply to any health or disability condition.  Although the ACA has been so highly politicized that it is difficult to discuss without triggering intense emotion, it is important for individuals with disabilities to examine what it will mean for their “ability to reach their full potential.”

The ACA, as we know, is Congress’ attempt to reign in the spiraling cost of health care to individuals, businesses and government.  The US Supreme Court recently found that doing so is a proper role for the federal government as long as it is done in a constitutional way.  (The way of doing it, they said, could be by taxation but not by using the Congressional power to regulate commerce.)  But a secondary effect of the ACA will be to expand the civil rights of individuals with disabilities.

Of course, we have had the ADA for over twenty years and the Rehabilitation Act for almost twice as long.  But one huge exception under these laws has been discrimination in health insurance coverage.  Put simply, insurance companies have been allowed to discriminate against people with disabilities if they can show that it saves money to do so.  The only way to combat this discrimination has been through mandatory coverage laws such as mental health parity.

The effect for people with disabilities has been to significantly add to their cost of living and create incentives for them to seek public support.  A person who could work may choose not to in order to keep health insurance.  DRO’s Benefits Planning program (which Social Security just defunded) was designed to help people with disabilities find a way to work and maintain benefits.  Sadly,  the ADA did not touch this area of discrimination that has a major effect upon people’s lives.

But now, the ACA says that insurance companies cannot deny coverage for people with pre-existing conditions.  They cannot throw a person off coverage because she gets too sick or costs too much.  They must fully cover preventive and diagnostic services.  They must provide coverage for mental health, chemical dependency, child vision and dental and “habilitation” services and devices.

Habilitation is like rehabilitation except that the goal is not to return a person to a previous level of functioning but to help a person to maintain or achieve a higher level of functioning.  An example is speech therapy for a child with a communication disorder.

Contrary to the claim by some politicians that the ACA will give people stuff for free, health insurance will continue to cost money.  But policy costs will not be controlled by excluding people with disabilities and use of other discriminatory practices.  A fairer approach, seen here in Oregon, is the state’s Health Care Transformation effort.  Oregon seeks to change the way health services are delivered in order to emphasize health maintenance rather than reward over-usage by some and exclusion of those who need services the most.

The ACA does not solve all problems for access to needed services but it points a way toward addressing the shared costs of our health care system in a fairer way.  Oregon is out front on these efforts.  This is good news.

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