Editorial report: health care reform.Since its introduction in September, we have reported regularly on the progress of President Clinton's health care reform proposal. We have received many letters urging us to continue these reports. We also have heard from a number of parents who shared their concerns--based on various reports--that children with disabilities may be shortchanged under the currently proposed plan. In December, for example, the Associated Press Associated Press: see news agency.
Associated Press (AP)
Cooperative news agency, the oldest and largest in the U.S. and long the largest in the world. reported on a hearing during which members of the Senate Finance Committee had acknowledged that children with "birth defects birth defects, abnormalities in physical or mental structure or function that are present at birth. They range from minor to seriously deforming or life-threatening. A major defect of some type occurs in approximately 3% of all births. or chronic health problems could be excluded from coverage under President Clinton's plan..."
In reviewing the following reports and commentaries, it is essential to remember that--despite perceived inadequacies-the President's proposal offers major reforms that vastly improve many aspects of the current health care system.
Two specific gaps in coverage for children with disabilities have been identified---outpatient rehabilitation services and "customized" durable medical equipment Durable medical equipment is a term of art used to describe certain Medicare benefits, that is, whether Medicare may pay for the item. The item is defined by Title XVIII the Social Security Act:
"Durable medical equipment" includes seating systems, wheelchairs and many other products. The health reform plan appears to cover "durable medical equipment" and "prosthetic pros·thet·ic
1. Serving as or relating to a prosthesis.
2. Of or relating to prosthetics.
serving as a substitute; pertaining to prostheses or to prosthetics. and orthotic orthotic /or·thot·ic/ (or-thot´ik) serving to protect or to restore or improve function; pertaining to the use or application of an orthosis.
Of or relating to orthotics. devices," while "customized devices" are excluded. Limiting coverage to "off-the-shelf" equipment presents a problem since devices for children are often customized--or individualized in·di·vid·u·al·ize
tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es
1. To give individuality to.
2. To consider or treat individually; particularize.
3. . Current health insurance coverage typically has similar limitations requiring parents to pay the difference in cost between the "generic" and "customized" versions of a product. This difference in cost, however, can be substantial.
Knowledgeable advocates have raised additional questions about how other services for children with disabilities will be covered. These include Medicaid payments for early intervention ear·ly intervention
n. Abbr. EI
A process of assessment and therapy provided to children, especially those younger than age 6, to facilitate normal cognitive and emotional development and to prevent developmental disability or delay. services, so-called "related services" such as therapies within special education programs, and EPSDT EPSDT Early and Periodic Screening, Diagnosis, and Treatment (Early and Periodic Screening, Diagnosis and Treatment) services. Concerns have also been raised about coverage for home care and community-based services for people with severe disabilities. Though the reform proposal includes some important services of this kind, it allows individual states to place restrictions on eligibility and types of services provided.
Write Now ! This month's coverage of health care reform includes our adaptation of a recent call to action prepared by the Consortium of Citizens with Disabilities. We also bring you the personal story of a Virginia family that was forced into bankruptcy by health care costs. We asked Larry Allen Larry Christopher Allen, Sr. (born on November 27, 1971 in Los Angeles, California) is an American football player who currently plays offensive guard for the San Francisco 49ers of the NFL. to share his family's story because it is all too typical of the health care horror stories that could be written by many families of children (or adults) with disabilities. Anne Lauritzen tells a similarly frightening story in the Informational Forum on page 42. The National Parent Network on Disabilities also urges everyone to get involved (see page 41).
We urge our readers is to make contact with their representatives in Congress. Do not hold back! Parents of children with disabilities and many dedicated advocates are struggling against the vast resources of those in our society who prefer the status quo [Latin, The existing state of things at any given date.] Status quo ante bellum means the state of things before the war. The status quo to be preserved by a preliminary injunction is the last actual, peaceable, uncontested status which preceded the pending controversy. .
In fact, we believe that it is time for our elected officials to receive letters from the most important individuals involved--children with disabilities and special health care needs. Though most parents and organizations are understandably cautious about involving their children in public advocacy campaigns, we believe that letters from children as well as parents are needed to sufficiently dramatize dram·a·tize
v. dram·a·tized, dram·a·tiz·ing, dram·a·tiz·es
1. To adapt (a literary work) for dramatic presentation, as in a theater or on television or radio.
2. the urgency of reform in health care for all individuals with disabilities. We hope our readers will encourage their children to write such letters and will send copies to us so that we may publish some in future issues of Exceptional Parent.
Remember--just a few months ago, the "Brady Bill" was facing imminent defeat in Congress. A dramatic groundswell ground·swell
1. A sudden gathering of force, as of public opinion: a groundswell of antiwar sentiment.
2. from everyday citizens turned the tide--the "Brady Bill" is now law. The health care reform proposals before Congress are vulnerable. The administration and members of Congress from both political parties are under enormous pressure to "settle for less." This pressure is very powerful--but not insurmountable.
Health Care Taxes
Any discussion of taxes makes elected officials and many citizens very anxious. It may well be necessary to address the need for additional tax revenues to pay for the critical changes in health care that are needed by children and adults with disabilities. However, we believe that the actual net cost to each family for health care--including current health insurance premiums, actual health care expenses which are not covered not covered Health care adjective Referring to a procedure, test or other health service to which a policy holder or insurance beneficiary is not entitled under the terms of the policy or payment system–eg, Medicare. Cf Covered. and possible health care taxes that may be required--may not increase. In addition, we believe that the health security that President Clinton proposes will greatly decrease the ever-present fear hanging over the heads of most Americans--what if a member of my family needs health care and it isn't covered? Think of it--this may be the decade when w-e will put aside our fears of both nuclear annihilation annihilation
In physics, a reaction in which a particle and its antiparticle (see antimatter) collide and disappear. The annihilation releases energy equal to the original mass m multiplied by the square of the speed of light c, or E = m and catastrophic health needs! The load off our minds could do wonders for our health.