Orthotic and prosthetic activists have fought hard to control the
parity message, working tirelessly to avoid any political
firestorms or buzzwords that divide instead of unite. At the same time, these
advocates, activists and lobbyists are informing individuals and legislators
about the benefits of parity and what it truly means — requiring plans
that cover O&P services to provide those benefits at the same level as
other surgical and medical benefits, with no separate caps, arbitrary
exclusions or lifetime limits for care. If you want to control a bill’s
message, you might as well start at the top. What was once the
Prosthetic and Orthotic Custom Parity Act is now the
Insurance Fairness for Amputees Act.
In front of the message
The word “parity” has long been associated with mental health
parity, according to Peter W. Thomas, JD, general counsel,
National Association for the Advancement of Orthotics and
Prosthetics (NAAOP). Due in part to a controversial mental health debate,
parity gained its detractors and staunch advocates. Some legislators have even
equated parity to a mandate, a divisive word within the halls of Congress that
in many political circles holds a negative connotation.
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“In the current political environment, Congress will reject
anything that sounds like a mandate,” Ryan Ball, government relations,
Orthotic and Prosthetic Group of America, told O&P Business News.
Changing the bill’s name to the Insurance Fairness for Amputees Act
counters this mischaracterization.
“Part of the reasoning behind the changing of the name was
conceptual,” Thomas told O&P Business News. “The advocates
in favor of prosthetic and orthotic parity legislation wanted to seize on a
word that better conveyed the goal of the legislation. The goal is fairness.
They wanted to ensure that people would not be limited to one prosthesis per
lifetime or a $2,000 cap on O&P devices. It is not fair and it is not how
they treat other benefits.”
The name change is certainly a messaging issue, but it is also to ensure
that consumers and legislators understand the law.
“There are no caps for stroke victims,” Dan Ignaszewski,
government relations coordinator,
Amputee Coalition (the Coalition), told O&P Business
News. “Insurance companies wouldn’t cap their spending at $5,000
or say ‘one stoke per lifetime.’ But that is what amputees face. We
need to eliminate cap restrictions on devices. People must have greater access
to prostheses or orthoses. The cost for insurance companies is minimal, but the
impact is immense.”
As of press time, 19 states have successfully passed parity bills, with
Utah being the latest state to sign parity into law in 2010. Eight states
(Connecticut, Delaware, Florida, Idaho, Minnesota, New York, Pennsylvania and
Washington) have introduced Insurance Fairness for Amputees bills this
legislative cycle. Nine more states (Alabama, Michigan, Nebraska, North Dakota,
Ohio, Oklahoma, South Carolina, Tennessee and Wisconsin) are reintroducing the
bill to their state legislators, according to Ignaszewski. At the federal
level, during the 111th Congress, the Prosthetic and Custom Orthotic Parity Act
(H.R. 2575) never made it out of committee, despite racking up 30 cosponsors.
The 111th Congress did little in the way of passing O&P legislation.
On April 8, the Insurance Fairness for Amputees Act (S. 773) was
reintroduced in the Senate. According to the NAAOP, Sen. Olympia Snowe (R-Me.)
and Sen. Tom Harkin (D-Iowa) introduced the bill. A similar bill is expected to
be introduced in the House of Representatives as well.
On June 14, the Delaware House of Representatives unanimously passed its
parity bill (House Bill 76), 38–0. A week later on June 21, the bill
unanimously passed the Delaware Senate, 21–0. As of press time, the bill
is being send to Gov. Jack Markell (D-Del.) for his consideration. The Amputee
Coalition expects Gov. Markell’s signature, which would make Delaware the
20th state to pass the Insurance Fairness for Amputees Act into law.
Although Thomas acknowledges that a bill can gain momentum if other
states follow suit, it is simply too soon to tell, and there are far too many
unknown variables to determine whether passage through the Delaware House and
Senate is the beginning of a momentum shift for the O&P profession, he
said. Ball agreed.
Eileen Levis, president, Pennsylvania O&P Society
(POPS) knows exactly what Ball is feeling. In November 2009, Levis talked with
O&P Business News about her 5-year struggle to get licensure passed
in Pennsylvania. The political climate in which she worked, along with board
freezes, made it difficult for the bill to move through the Pennsylvania
More than 20 months later, Levis is still in the midst of the pursuit
— and making significant progress, thanks to a change in the Pennsylvania
political climate. The sponsor of the bill, Rep.Mario Scavello (R-Pa.), is now
looked on favorably by state legislators, according to Levis, which has
increased the likelihood of the bill’s passage. On May 2, the Pennsylvania
state licensure bill (H.R. 48) passed the state House by a vote of 174–20.
“It is going to be introduced into the Senate,” she said.
“There is no opposition to the bill that we know of and it should fly out
of the Senate. We are hoping it will pass this session; if not, then hopefully
by the end of the year. The next step is Gov. Tom Corbett (R-Pa.) will sign it
into law and then we will work on establishing a licensure board. There will be
a lot of work ahead.”
A continuous process
Terry Supan, CPO, FAAOP, FISPO, president and chief executive officer,
Supan Prosthetic Orthotic Consultations, a veteran of the licensure process,
suggested researching the information that is already on the Web or through
phone calls with people who have or are currently working through the political
gauntlet like Levis and Ball.
“The biggest recommendation I could give is that interested parties
need to plan on having a lobbyist involved in the process,” Supan told
O&P Business News. “Lobbyists can be expensive, but the more
you have done ahead of time for them, the more you are going to save. Still,
lobbyists can help you navigate through the processes so you do not get lost in
Levis had the same lobbying group for several years. and as time moved
on, their visions began to differ. This year, POPS retained former Gov. Tom
Ridge’s lobbying firm, the Ridge Policy Group. The combination of a change
in political climate as well as a change in POPS’s lobbying firm had a
significant impact on the bill’s passage. The connections of the new
lobbying group, as well as the respect it garnered, shined a new light on the
“The process was a continuum,” Levis said. “The process
evolved as time went on, and there were a number of unforeseen variables in
Pennsylvania. During one of the years, there was an absolute freeze in
establishing new licensure boards. So we were up against the wall. It was a
long winding road rather than a series of starts, stops and redos.”
Luckily for the industry, O&P is a feel-good piece of legislation.
Lobbyists have a narrative that strikes members of both sides of the aisle and
in both houses of government.
“You are doing something for people who are already
disadvantaged,” Supan said. “It is pretty easy to sell that to the
To sell the message, advocates, patients, practitioners and supporters
must take the time to email or call their congressional leaders, according to
Thomas. Follow-up phone calls from advocacy groups as opposed to a single
individual can make a greater impact.
“People don’t know the power they really have,” Thomas
said. “In this day in age, everyone is picking up the phone and calling
their congressman or congresswoman. It’s important for groups of people to
contact their congressional leaders and talk about these bills in order to get
some traction. You can’t make one phone call and be done with it. Often,
it takes some involvement in the political process.”
When meeting with legislators, Ball knew he was just one of perhaps as
many as 15 meetings that day. He needed to make his presence felt. He needed to
Thomas suggested visiting the congressman or congresswoman when they are
at their offices or events that they may hold. Schedule meetings or attend
dinners that the legislator is also attending. Become a recognizable face.
Perhaps an O&P practitioner can even invite the legislator to their
facility to show them what O&P care is all about, he suggested.
“I can see why it can be daunting to call your congressional leader
and expect him or her to automatically jump on board,” Thomas said.
“But that is how it’s done.” — by Anthony Calabro
For more information
- American Academy of Orthotists and Prosthetists. O&P
Licensure: A Comprehensive Guide. Available at:
June 29, 2011.
- Calabro A. Roadblocks to licensure. O&P Business News.
- O&P Makes Licensure Gains in Pennsylvania. AOPA in
- Pavlou S. Prosthetic parity: In the midst of health care reform.
O&P Business News. 2010; 19(9):13-20.
- Sen. Mikulski (D-Md.) sends letter to HHS on behalf of O&P as
an ‘Essential Health Benefit.’ AOPA in Advance. 2011;15(10).