Back in January, we started a series looking at what it would mean for people with disabilities if Congress were to repeal the Affordable Care Act, or “Obamacare.” Then we saw what might be on the docket: On March 4, Paul Ryan and other members of Congress introduced the “American Health Care Act of 2017,” or the AHCA. After a good amount of political turmoil and public pressure, the AHCA was pulled off the floor on March 24. It was widely viewed as a political defeat for many Republican leaders — and for the meantime, Obamacare is still on the books.
The ACA certainly looks better for people with disabilities than the AHCA proposal, so it’s a good thing for now.
We wrote about four major parts of the ACA that shouldn’t be repealed no matter what the next steps are (check those out here, here, here and here). But the whole debacle around the AHCA also got us thinking: What else could we provide to better serve people with disabilities going forward? How could we expand and improve Obamacare, or if a “repeal and replace” goes through, what should it have to make our lives better?
Here are a few things that came to mind, and what they could do.
Guarantee coverage to all durable medical equipment including scooters, walkers and wheelchairs.
While the Affordable Care Act requires insurance to cover some DME such as breast pumps for new mothers, it says nothing about many mobility devices including scooters, walkers and wheelchairs. These devices and their repairs can cost thousands upon thousands of dollars, which is well out of the range of many people with disabilities (and we shouldn’t have to pay for them out-of-pocket anyway).
Any healthcare revisions should guarantee access to these devices so that people can move about their home and in the community without destroying their savings or going into debt. Medicare, Medicaid and private insurance should also ensure that DME is high quality. Good equipment allows people maximum independence and can help with posture, comfort, skin quality and other health factors.
Ensure quality, guaranteed services in Medicaid regardless of state residence
Different states provide different Medicaid services and some are far better than others. The government can identify the highest-quality benefits and re-set that as a new benchmark, so people with disabilities are brought up to a strong level of care. This also requires smart Medicaid funding with enough coming from the federal government to help states out.
Improve work and savings rules for Medicaid nationwide
People with disabilities are often locked into poverty just to keep their life-saving Medicaid, as programs have a $2,000 “asset limit” and earning thresholds as well. There is already some progress and it needs to keep expanding. For example, some people with disabilities can save in ABLE Accounts without jeopardizing SSI or Medicaid, but ABLE is limited to those who acquired their disability before age 26.
Some states also have programs where people with disabilities can work and contribute a co-pay to keep Medicaid (people in California can even earn up to $60,420 under the Working Disabled Program), but some are far more generous than others. Existing law can be built on and improved: The ABLE age limit should be increased or eliminated, and states should have baseline rules for “work incentives” for people to earn money and keep vital health care. There are also plenty more opportunities that lawmakers can explore.
These are just some of the improvements that we can make to our health care system, but there are plenty more ranging from expanded home and community-based services to lowering drug prices. We all need to have this conversation and keep pushing for improvements, whether politicians are working on “repealing and replacing” existing law or if they’re just standing by.
Want to share your thoughts on my suggestions, or put forward some recommendations of your own? Let us know in the comments section below!