The 2008 legislative sessions across the United States welcomed many accompanying milestones. The Prosthetic Parity Act, a federal bill that would grant access to appropriate medical care for amputees nationwide, was introduced in March. Three more states — Indiana, New Jersey and Vermont — signed prosthetic parity bills into law, pushing the total number of states into double-digit territory.
Additionally, 15 states introduced bills in 2008, another six are poised to do so in 2009 and eight more states are working to build campaigns, explained Morgan Sheets, national advocacy director for the Amputee Coalition of America (ACA).
“Whenever a bill passes I feel like we get a state or two or three that weren’t involved before or weren’t active, who get enthusiastic and want to get going,” Sheets told O&P Business News. “We first started hearing from Minnesota right after the Indiana bill passed and when Vermont passed we had a few people who were inquiring about what was going on in their state, and were also interested in the federal initiative. Every time another one passes we get additional interest.”
In the third year of legislative action, the Connecticut prosthetic parity bill was pulled from consideration because of amendments. After the bill was introduced to the Joint Committee on Insurance and Real Estate earlier this year, a cap of $2,500 per limb was incorporated. But the fight is not over for Connecticut.
Leadership changes following elections should bode well for the bill when it is reintroduced in 2009, sponsor Rep. John Geragosian explained.
“There will definitely be some changes in leadership … and maybe a new makeup of the Joint Committee on Insurance and Real Estate which might allow for a more favorable bill next year because we have a new Speaker of the House coming in,” he said.
Sheets and Geragosian agree that supporters in Connecticut remain committed to passing this legislation and more specifically, gaining the coverage they need. Geragosian said the bill he intends to reintroduce will provide for complete coverage. To prepare for the next step in this battle, he plans to meet with local advocates later this year to craft the bill they want to launch.
“These things take awhile and I think that over time it will pass because it is the right thing to do,” Geragosian said. “The local advocates are active and I think my colleagues will look favorably on the bill when they get it in front of them…it is the process that sometimes gets in the way.”
Louisiana is set to be the 11th state inaugurated into the group with prosthetic parity bills signed into law. At press time, the bill had passed through the House and the Senate and was on Gov. Bobby Jindal’s desk awaiting a decision.
The last year has been a busy one in terms of the Louisiana prosthetic parity bill’s movement through the legislature. Just last year, parity advocates were beginning their campaign. But despite the quickness with which this decision has been reached, the roadblocks were plentiful.
Gina Goings, lobbyist for the Louisiana effort explained that the opposition from the business community was fierce.
“They are powerful organizations with numerous lobbyists and they also have the ability to activate grassroots. That was a big struggle because they were opposing the bill on the basis that it was a mandate,” she said.
To overcome this struggle and spread awareness, they relied on relentless lobbying, Goings said — expressing that Rep. Chuck Kleckley worked tirelessly for the effort — and personal testimonies.
“It is nothing to have two or three [patients] a day that would come in that we couldn’t do anything for because they were capped with insurance,” John Moore, president of the Louisiana Association of Orthotists and Prosthetists said. “As they came in the door we would tell them what we are trying to do and ask them to call their representative and we had a lot of patients call. If you don’t get the patients involved, we are just another vendor as far as these representatives are concerned.”
It is hoped that will no longer be the case. Moore also said that previous passages were helpful in proving their point to legislators and insurance companies.
The Maryland prosthetic parity bill is currently undergoing a cost impact analysis, as do all proposed mandate bills within the state of Maryland, regulated by the Healthcare Commission.
“The cost impact analysis has been positive and only strengthens our argument when the bill comes up in the next session,” John J. Rush, MD, chief medical officer for Hanger Orthopedic Group, Inc. explained.
“It has gotten a warm reception from every legislator I have spoken with,” Rush said, crediting much of the success to previous successes. “Racking up wins in 10 states and now Louisiana has passed in the House and the Senate and is now sitting on the governor’s desk — that momentum certainly signals that it is an issue that other states have dealt with effectively.”
What sets Maryland apart from other states is that in addition to Medicare, Medicaid and the Department of Veterans Affairs, who all provide prosthetic coverage without caps or restrictions, so do non-profit insurance companies.
Rush expects Maryland to be added to the growing list of states with prosthetic parity laws within the next year. He advises states working to build a campaign to work closely with the ACA, hire a lobbyist who will work effectively for the cause and to have the bill sponsored by the state coalition of the ACA, as opposed to the O&P society of that state to ward off a self-serving attack.
The 2008 legislative session gave the Missouri bill a chance to begin movement. The bill was referred to the Senate committee and passed but session adjourned before the bill could be heard on the floor. Organizers, Jeff Damerall, Jean Freeman and Bill McLellan are all pleased with the movement and reception the bill has received thus far.
“We are looking forward to the next session in 2009 and having a prosthetic parity bill put forward in the House and the Senate,” Freeman said. “We were happy with the turnout for the Senate and the House hearings but particularly the House hearings. We had 20 to 30 individuals there … and it made an impression on the representatives.”
McLellan explained that the Missouri prosthetic parity bill was coupled with an autism parity bill and in the process was amended to become a mandated offer bill instead of a pure mandate.
“An offer … requires health insurance companies to offer to sell individuals and companies policies that include prosthetic coverage but not all of their policies have to include prosthetic coverage,” McLellan said. “So companies and individuals can choose to buy less expensive policies that don’t include prosthetic coverage. This was a compromise we were willing to make with the insurance companies in our first year.”
Despite the compromise, the bill stalled. The bill will be reintroduced in January 2009 to a better educated and informed group of legislators.
“We have made a lot of headway with individual legislators and bringing in that momentum which is helpful,” Damerall said.
When the bill is reintroduced, that momentum will be particularly important as they are expecting to enlist new sponsors for the bill as well as additional legislators for support.
“We are trying for everything we want,” Damerall said, explaining that they are aiming to change the language once again for full coverage. This time we are saying that if you provide individual coverage or group coverage, small group coverage, whatever coverage you are going to provide the benefit not just the offer.”
To continue the momentum and keep motivations high, the Missouri campaign is planning a number of events this summer which they hope will continue to raise awareness.
Unfortunately, the Utah prosthetic parity bill was voted down this year in the Business and Labor committee. Despite this disappointment, local activist Tami Stanley and Sheets are celebrating.
“It was still an exciting effort because in the beginning, we couldn’t even get a sponsor in Utah,” Sheets said. “Now there is actually a set of legislators who are working with our lead activist to collect some data and build some additional support to bring the bill up again.”
Stanley concurred, noting the difficulties that have motivated the movement.
“We were ecstatic with how far it went this year,” she said. “The insurances have given us a really difficult time. It is going to be a process but it is very much alive and the media have gotten ahold of it. All the legislators know about it so it is just a matter of working through details.”
The legislators wanted to ultimately pass some sort of parity legislation without a mandate. Stanley visited several insurance company offices with legislators to speak to them firsthand.
“They flat out said that it is never going to happen without a mandate. That was what they needed to hear.”
To build additional awareness, the campaign has been holding grassroots meetings throughout different counties to encourage more amputees to come forth as advocates for the next attempt.
The process in fighting for prosthetic parity has been particularly grueling in Virginia, where the bill was referred to a mandated insurance commission and two seperate reviews conducted by the Commerce and Labor Committee and the Finance Committee, which both returned positive reviews. Sheets said one of the reviews was conducted by a commission that is notoriously known for opposition. The bill was then sent to the Senate floor for a vote and was referred again to the Commerce and Labor committee.
Charlie Coulter, a lead activist in Virginia, is not losing any steam despite the disappointing turn of events.
“We have renewed the contract with the lobbyist,” he said. “They have identified legislators who they would like to talk to. We are going to try to speak to as many legislators as we can between now and the start of the session at their home offices.”
Coulter also explained that he and colleague J. Douglas Call, CP of Virginia Prosthetics went around the state summoning the much-needed support of O&P business owners. Call and Coulter expressed their thanks and appreciation toward the business owners who have pledged their support and implore other business owners to join this difficult fight.
“We were disappointed but it will be moved again in the House and the Senate next year and our sponsors are committed,” Sheets said.
States to watch in 2009
There are eight states working with the ACA to build campaigns or introduce bills during the 2009 legislative session: Delaware, Georgia, Michigan, North Carolina, Tennessee, Texas, Washington and Wisconsin.
An additional eight states — Montana, Ohio, Oklahoma, Florida, Arizona, Idaho, Alaska and Minnesota — are working to see if they can build an effort
“There are a lot of committed activists out there working on these bills and it certainly takes committed activists because it is an uphill effort. In some states, it is far more difficult than others,” Sheets said. “I do think it is to our advantage to keep hammering on it.”
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- Note: At the time of publication, Louisiana’s prosthetic parity bill passed through both the Senate and the House and was waiting to be signed into law.
Jennifer Hoydicz is a staff writer for O&P Business News.