A Record Year for Prosthetic Parity

This year, good news has been hard to find within the depths of economic turmoil that has flooded global as well as industry news. Legislatively, some might expect that parity efforts have dwindled and taken a backseat to other, but not more imperative, concerns, but the contrary is taking place in legislative offices across the country.

The Amputee Coalition of America (ACA), along with the support of amputees, O&P facility owners and practitioners, activists and professional O&P organizations, is winding down the first half of a record year in the almost decade-long push for parity. What started with one passage, Colorado, in 2001 has led to increased awareness and a more than 25% adoption of parity bills throughout the 50 states. There were seven victories in 2009 – Arkansas, Maryland, Iowa, Missouri, Virginia, Texas and Connecticut.

The Connecticut parity legislation was vetoed by the governor. The ACA and local activists waged a strong override effort, but came up short. They are committed to advancing the bill in the upcoming session. Despite this setback, this session still provided a lot of cause for celebration with six new states for a total of 17 states that have enacted parity legislation.

United States map

Projections for 2009

Despite the dark cloud looming over state budgets, the ACA forged ahead with their mission and their message in 2009. They aimed to capitalize on an otherwise negative situation by reminding lawmakers of the vital importance of getting amputees up and moving again.

“In this economy people are not going to be able to fill huge gaps in coverage,” Morgan Sheets, national advocacy director for the ACA, told O&P Business News. “What we decided to do was highlight those types of arguments in terms of keeping people working so that they’re paying taxes and they are productive members of society. I think that has always resonated but perhaps in this economy, even more.”

Sheets said that the economy sent the reality of the issue home to the lawmakers pointing out that even the most drastic measures that amputees could take to bridge the monetary gap, including dipping into savings and retirement funds or even taking a second mortgage on a home, might be unavailable this time around.

“People are having to do that sometimes even just to get by so how are they supposed to then also find that extra money?” she said. “It did help to highlight the situations that these restrictions put people in.”

Sheets also credits a successful 2009 to the hard work and success they have experienced in prior years.

“We were in a good place so I think [the success is due to] the work that we’ve put in to build the infrastructure and craft the message and build strong campaign committees, in combination with people understanding the drastic economic situation,” Sheets said. “I think those things in partnership, helped us this year.”

In this article, O&P Business News highlights the progress and success being made by states across the nation this year.


As a new state involved in the push for prosthetic parity, activists in Arizona are working to build momentum and spread awareness about their new campaign.

The effort began at the 2007 ACA Conference and has been gaining momentum ever since. Tina Wendelschafer, chairperson of the committee working to advance legislation, is focusing on involvement and education at this stage of the process stressing the importance of practitioner influence, especially when it comes to educating patients.

“We would love for the practitioners to get more involved in this,” she said. “We’re all in this together.”

The committee has secured a name for themselves – AMPS-United – and at press time was creating a Web site to also help spread their message.

Their main goal over the summer remains to contact as many people as possible through flyers, phone calls and e-mails centered on education. Furthering this mission, the group has planned several fundraisers for this upcoming Veterans Day in November. A concert and a walk are scheduled to take place in Phoenix.

Wendelschafer explained that they are also working on a 1000-signature campaign that would bring the bill closer to a floor vote.

North Carolina

Like Arizona, activists in North Carolina are currently organizing resources to prepare for bill presentation.

The legislature in that state, however, demands certain prerequisites before securing a sponsor for the parity bill.

“We have to present [a draft of the bill] to Blue Cross Blue Shield and have them tell us that they will not oppose it in order to get a sponsor for the bill,” Ashlie White, leader of the campaign efforts, said. “It’s as clear as it can be. The senators and the legislators in the state have all told us the same thing. If we can get confirmation from Blue Cross Blue Shield that they will not oppose the bill, they will help us.”

Despite this extra roadblock, White explains that they have seen a lot of progress in North Carolina with regards to O&P awareness due to their situation with Medicaid.

“Every few years we have to fight the Medicaid battle to keep O&P for adults in North Carolina. When the budget cuts happen, they have to go through what services they provide for adults and unfortunately because the government still lumps O&P with durable medical equipment, they cut that,” White said.

But there may be an upside to this biennial debate: visibility.

“We have these people who are already aware of issues in the state,” she said. “It’s not like we go away for years at a time and now we’re trying to fight a battle. O&P in North Carolina has always had these challenges. It is not the most comfortable situation to be in but at the same time it helps us to stay fresh.”

With that in mind, White has a lot of confidence in their prosthetic parity bill and is working to keep the numbers of those involved on the climb. Luckily, there are several groups throughout the state working together to make parity a reality and they are hopeful about introducing a bill in the next legislative session.


In 2008, activists in Illinois introduced a Senate bill that died in legislature. For 2009, they took a different approach with the House.

They presented a bill that included both orthotics and prosthetics and was crafted with language on which they felt they could compromise with lawmakers.

“[In the House] we actually ran into … some strong resistance from what we thought was the insurance lobby but actually the [insurance companies] really did not oppose the language of this legislation,” Jim Kaiser, Illinois leader for prosthetic parity, said. “They weren’t in favor of it but they didn’t oppose it.”

Instead the opposition came from the Illinois Manufacturer’s Association, the Illinois Chamber of Commerce and the National Foundation of Independent Businesses with regard to the impact this mandate would have on small businesses.

Despite three separate attempts to negotiate and one attempt to place a cap on the bill, dialogue shut down.

“They wouldn’t deal with us whatsoever,” Kaiser said explaining that despite this obstacle, their sponsor proceeded to push the bill and it was passed out of the House without any textual changes.

Introducing it in the Senate proved to be a larger challenge and the Illinois state sponsor decided to hold off on introduction for fear it would die in session as it did in 2008. Currently, they are waiting to have it called for a vote in the November session.

“It’s not dead,” Kaiser stressed. “Our lobbyist had a dinner with our sponsor last week who said he now felt that he had the support of more of the Democrats on the insurance committee.”

Over the summer activists are setting up grassroots efforts and are looking to make aggressive individual contact with key senators.

“We have to … get patients involved,” Kaiser said. “From the practitioner and the business perspective this looks like a special interest piece of legislation and it will never fly. We have to be engaged in this process. If we’re not engaged in it, it will go nowhere because nobody’s going to do it for us.”


On May 11, the Minnesota parity bill was introduced to legislators. Now that the session is closed, activists are working towards clarifying the language of the bill and perhaps extending that coverage into orthotics.

To reach this point, local activist Cate Braun explained that, the Minnesota Society for Orthotists, Prosthetists and Pedorthists formed a committee to investigate parity last year and then began outreach to patients and began the formation of patient advocacy groups.

Now they are preparing to meet with different representatives around the state to stress the importance of their vote for the bill.

“It will be up on the agenda and in committee for discussion in February when the legislature resumes,” Braun said, explaining that introduction of the bill was not expected to take place in 2009. “Because of this, we are unaware of any opposition and hoping to get in and out of committee without much resistance.”

To further the mission, Braun has advice for those who want to get involved.

“We’re looking for a more active role from the facility owners and clinicians so that they are educating and talking to their patients and then the patients are talking to legislators,” Braun said. “We are looking at growing the ground force. We’ve got a lot of time but we need people to start becoming aware and getting their patients more involved.”


Among the seven successes of 2009, Texas has been working for more than 2 years to pass parity legislation.

Despite their setbacks in 2007 and over the course of one year without any legislative activity due to the structure of the government, activists in Texas were prepared with new strategies to make sure that 2009 saw success.

“We focused on whatever committee our bill was with,” Mona Patel, leader of the Texas movement, said. “The House bill was the one that had the movement so that was what we focused on.”

Before the bill was heard by each House committee, activists made sure they scheduled a meeting with those members to discuss key facts and figures.

“The House bill had fast movement to the House floor. Then we knew the Senate was going to be a little bit tougher due to the makeup of the Senate and knowing that that’s where the bill died last session,” Patel said.

From there the bill was sent to the Senate State Affairs Committee that is historically opposed to passing mandates.

“We chose to spend our time with a few of those staffers and chiefs of staff and they wanted specific information for Texas,” Patel said.

Following a hearing with the State Affairs Committee, for which 25 amputees came out willing to provide testimony, the bill was voted out of subcommittee and back to committee and then it was scheduled for a vote on the Senate floor. It was a unanimous vote in favor of the bill.

“It’s a testimony that grassroots really can work,” Patel said of the success in Texas. “You need a lot of heart, a lot of dedication and perseverance.”

Among Patel’s recommendations for other states looking to push this bill are: confidence and a united front.

“Be visible. Stay determined and [don’t] lose focus of what your end goal is,” she said.


In addition to Texas, Virginia also saw the success of having their parity legislation signed into law in 2009 in what Sheets and Charlie Coulter, of Virginia Prosthetics and leader of the Virginia movement, call the most difficult passage yet.

The bill presented in 2007 was referred to the Mandated Benefits Review Committee which, according to Coulter, killed any chance for movement in that legislative session due to timing.

“We took patients to testify,” Coulter said. “I was told it was one of the most exhaustive hearings they’ve ever had and that the report by the Joint Legislative Audit and Review Commission (JLARC) was one of the most positive. I thought this was a shoe-in. That’s when I learned about partisan politics. In the spring of 2008 it was reintroduced, and referred to committee where, in spite of favorable studies, it was stonewalled by a majority of Republicans who chose to ignore their own JLARC report.”

Despite fiscal impact study results showing that there were no additional costs to the state to enact the law, according to Coulter, there were attempts to derail the efforts and allegedly misinformation was dispensed, which hurt the bill’s chances.

In the summer of 2008, a lobbyist was hired and groundwork was started, which led to the passage of the mandated offer in the first legislative session of 2009. The bill will go into effect in January 2010.

“At least what we’re getting is disclosure, opportunity and choice,” Coulter said regarding the bill being passed as an offer as opposed to a benefit. “We are hopeful that the market will drive this at a reasonable rate. In California it seems to be working fine.”

Coulter urges other states trying to pass a parity bill to present with a unified voice.

“It has never been more important for small businesses to form a state association,” he said. “Unfortunately our business has been historically [comprised of] small practices and I think people are leery of joining with their competitors in any way. The only way to get this across is to band together as an association.”

Look ahead to 2010

To gear up for the 2010 session, the ACA is working with local activists to hold organizing meetings throughout the country June-September. They are also developing a toolkit that can be used to generate grassroots organizing initiatives to support the state bills.

Federal push

The slogan for the Prosthetic and Customized Orthotic Parity Act – arms and legs are not a luxury – is certainly being heard through the ACA’s recent efforts to push the legislation forward.

“We had a successful lobby day in March,” Sheets said. “We had 200 people from 34 states, which was way beyond our original goals and expectations.”

Throughout the country, parity leaders have been meeting with legislators while on recess in their district offices.

Simultaneously, the ACA advocacy department has been on the Hill every week meeting in the House and Senate offices.

“The ACA has been on the Hill at the same time that our activists are in the district offices and doing countless e-mails, call-in days, letters,” Sheets said. “We have also been dropping information and stories off to targeted offices every couple of weeks just to keep momentum going.”

The ACA is working in collaboration with several leading health and disability organizations, including the American Orthotic and Prosthetic Association (AOPA). The ACA recently partnered with AOPA to launch an ad in the July issues of Business Week, Newsweek, Time, Forbes and U.S. News and World Report. The goal of the ad is to raise awareness and build support for the Prosthetic and Orthotic Parity Act (HR 2575) and the Medicare Improvements Act (HR 2479). The ACA has also been working with AOPA and other partners on issues related to health care reform and people with limb loss.

Sheets explained that in addition to the push for nationwide coverage, much of their time more recently has been spent wrapped up in the health care reform debate.

“We’ve been spending a lot of time on that and trying to push to make sure there’s appropriate and adequate coverage for people with limb loss in the national health care reform bill,” Sheets said. “It is our role to ensure that the specific needs of amputees are not left out in the larger discussion around the benefits and delivery of health care in this country.”

Sheets is confident that with the hard work and leadership of the ACA, their activists and coalition partners, language will be included in the final health care reform legislation that will help to advance protections for people with limb loss and their health care needs.

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Jennifer Hoydicz is the managing editor of O&P Business News.

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