Update: Prosthetic Parity Across the Nation

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.

Fighting for 50 Momentum keeps climbing in the state-by-state battle for prosthetic parity and now the ACA has launched a bill aimed for a larger target that will include all 50 states — a federal prosthetic parity campaign. Introduced on March 13 by sponsor Rep. Robert Andrews, the Prosthetic Parity Act (HR5615) seeks to raise the required coverage level for prosthetic devices to meet the standards provided for other areas of essential medical care nationwide. “From the insurance industry’s point of view, mandates that provide prosthetic devices are cost-effective in the long run,” Andrews told O&P Business News. “The avoidance of secondary problems for a person who needs a prosthetic device — the benefit of that far outweighs the cost of providing the device.” Why battle federally? A federal passage would not override those hard-fought battles in the 11 states with prosthetic parity bills passed, Sheets said. If previously passed bills allot for coverage beyond this level, those benefits will remain unchanged. “Only 45% of Americans have health insurance that is regulated in their state,” Rush said. “So even if we pass prosthetic parity bills in all 50 states, that would only affect 45% of Americans with insurance. To get the other 55% that are covered under federal ARISA regulations, you need a federal bill.” According to both Sheets and Rush, the bill is receiving a warm reception from legislators at the federal level. “Legislators who are educated certainly see the need for it and it is going through the political process which is time consuming,” Rush said. “There is no legislator that I have spoken with — even those who are fundamentally opposed to mandates — who, once they hear the merits of the bill, isn’t behind it.” Andrews, who is confident that the bill will eventually become law through a larger health care reform, noted that the insurance industry is opposing the bill in the early stages. “The general position is that they are not in favor of any mandated benefits but I think that is a position we will be able to persuade them to change based on the cost-benefit analysis,” he said. Practice patience Now is the right time to pursue this legislation given the parity successes, as well as continuing parity movement through many of the remaining 39 states. Coupled with the media attention for returning amputee service members, as well as amputees who have recently appeared on popular television programs, the legislative iron is hot. Recognizing that federal laws can take longer to pass, the ACA is getting organized and raising awareness to build additional support for the bill. The ACA also sponsored the first national week of action, April 26 – May 2, which was a simultaneous event across 35 states and also marked the official launch of the Prosthetic Parity Act. “There were more than 98 events in 89 different cities in 35 states,” Sheets said of the event. “We sent out more than 10,000 postcards regarding the federal effort. We launched an online petition in support of the federal parity bill and less than 2 months later, we have almost 5,000 signatures.” On the same note, the ACA held a lobby day on June 11 and invited amputees from around the country to come together in support of the federal prosthetic parity bill to meet with House and Senate members. Those who could not attend were urged to call their representative to make the cause known. The ACA is using this first year as a means of introduction and education, so that it can create a strong presence from which to reintroduce the bill in January 2009. “We foresee that this could take several years but obviously the benefit of it for amputees across the country is clearly worth the investment,” Sheets said. For more information: www.amputee-coalition.org

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.

2008 Success Stories Three new states adopted prosthetic parity bills throughout the 2008 legislative session. O&P Business News talked to representatives of those movements to find out what led to their success. Indiana Indiana began their fight for prosthetic parity in early 2007 with the formation of the Indiana Amputee Insurance Protection Coalition and never lost momentum. The coalition testified before the Health Finance Commission in September and formally introduced the bill in January of this year. With the passion of the group and spokesperson Marifran Mattson to help see this bill through, it was signed into law on March 21. “Initially it was brought to my attention by my prosthetist and he challenged me to go to the initial meeting so that is personally how I got involved,” Mattson said of her modest entry into the group. Despite being told not to try for the bill, the coalition pushed on with the understanding that there was no justifying prolonging the wait for coverage. “You do need a small group of committed people because it does take a certain amount of time and energy,” Mattson said offering advice to other states. “I think it is important to do your research … and contact other states. Don’t reinvent the wheel.” New Jersey A movement that began in 2004, the New Jersey prosthetic parity campaign, knows the difficulties that accompany such a large undertaking. In the first year of legislation, the bill died in committee and was reintroduced the following year when momentum began to pick up. This time, the bill passed out of committee but could not move on before session adjourned. Third time is a charm as the legislation moved on for the third year and passed the Senate unopposed. The New Jersey prosthetic parity bill was signed into law on Jan. 7, a good start to the new year. Earlier this year, Nancy Pinkin, the lead lobbyist on the New Jersey campaign told O&P Business News that she employed every lobbying effort imaginable to see this law come to pass. “We pulled out every effort and every single one was crucial,” she said. Equally important was the amount of support granted by the O&P business owners across the state. Vermont Vermont rang in the new year by spreading awareness about prosthetic parity throughout the legislature and introducing the Senate bill on Jan. 1. Eileen Casey is now a well-known name throughout the Vermont legislature. Willing to share her story again and again, Casey took on the role of campaign spokesperson – a role that Sheets said was one critical aspect of the movement. “Having a good spokesperson who engages people and strong sponsors plus the states political climate and history created the ideal breeding grounds for this bill,” Sheets said. On April 23, the Vermont parity bill was signed into law. “The whole country is facing this health care epidemic,” Casey. “It is a little tiny spark of hope that is visual that people can see that at least you are making efforts to change.” For more information: www.amputee-coalition.org To read complete coverage of the New Jersey passage, see “New Jersey Passes Parity Legislation” in the March 1, 2008 issue of O&P Business News. Editor’s Note: As of press time, Louisiana’s prosthetic parity bill passed through both the Senate and the House and the bill was waiting to be signed into law.

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.”

Parity Laws State-by-State The 2008 legislative season marked three more victories for the national battle for prosthetic parity. Following are the years the 10 states passed their parity laws. Colorado – 2000 California – 2006 Maine – 2003 Oregon – 2007 New Hampshire – 2004 New Jersey – 2008 Rhode Island – 2006 Indiana – 2008 Massachusetts – 2006 Vermont – 2008

For more information:

• www.amputee-coalition.org/advocacy/index.html
• 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.