Disability Rights Legal Center – The Health Care Act

ACA - Uninsured Need Access to Preventative Care

A central tenet to our work in championing the rights of people with disabilities includes promoting access to adequate, affordable healthcare for those with health conditions, including pre-existing ones such as cancer. In accordance with this mission, the DRLC recently submitted an amicus brief to the United States Supreme Court in support of the Patient Protection and Affordable Care Act (ACA), otherwise known as “Healthcare Reform.”

An “amicus brief”—literally a “friend-of-the-court brief”—is used to inform the national debate when important legal issues are being decided; interested individuals or groups are allowed to provide additional arguments that might otherwise get overlooked by the named parties.

One of the primary issues before the Court in this case was whether Congress acted under its Constitutionally authorized powers when it sought to expand Medicaid, a national program that now provides medical care to low-income individuals who are blind, 65 or older, or have a disability—also known as Medicaid’s “Aged, Blind, and Disabled” program.

If the law is upheld, the ACA is set to expand Medicaid eligibility to all low-income individuals (below 138 percent of the Federal Poverty Line) by 2014, and will provide a source of health-care coverage and significant Medicaid subsidies to those who need it most. The ACA shifts a significant cost away from state and local governments, and uses federal funds to pay for the vast majority of the program’s expansion.

In writing our brief, we drew on the vast knowledge of the Cancer Legal Resource Center (CLRC), a national, joint program between the DRLC and Loyola Law School Los Angeles, to make strong arguments supporting the Affordable Care Act. From the CLRC’s work with populations affected by cancer, the DRLC directly understands that access to government benefits such as Medicaid is an area of primary concern to all people with chronic illness and their families.

Medicaid expansion seeks to address a significant national issue: The number of people uninsured for medical coverage in this country has reached epidemic proportions. Over 50 million people have no medical coverage, according to the 2010 Census. The high cost of private insurance and limited opportunities for low-income people seeking affordable alternatives, lead to a high population of uninsured, forcing many to miss out on life-saving preventative care before diseases advance to uncontrolled limits.

Cancer, in particular, is a disease whose treatment plan and prognosis varies widely, depending on the stage at which it is detected. Regular screenings for diseases, such as cancer, can result in early detection and removal of cancerous growths when the disease is most treatable and the chance of survival is highest. Chronic-condition diagnoses such as cancer most often occur when a person is least prepared: Many uninsured individuals learn of their diagnosis through an emergency-care facility after the condition or disease has advanced to a point in which it is too late to continue to ignore, only to then find that they are now excluded from other care options due to pre-existing condition exclusions put in place by private health-insurance providers.

As a whole, uninsured individuals are more likely than insured individuals to seek medical intervention only when faced with an emergency. They tend not to seek preventive care or not to put as much effort into  managing their chronic health conditions, and they tend to rely heavily upon urgent-care facilities.

The good news for low-income uninsured individuals who are diagnosed through this process is that after diagnosis, they may then be eligible for Medicaid under the current system because many chronic conditions qualify as “disabilities” in the Aged, Blind and Disabled program. Unfortunately, many may become eligible only after it is too late to stop progression of the disease, or find an alternative, more affordable treatment option.

Using cancer as a lens to illustrate the experience of all people with chronic illnesses, the DRLC’s brief demonstrated that when low-income uninsured individuals have access to preventive medical services, the long-term health care costs borne by state and local governments go down. Indeed, when serious health conditions such as cancer are caught early, treatment is generally shorter and less expensive. Moreover, costs associated with emergency room services are reduced because individuals who have health insurance are able to be proactive about screening and early detection and are more likely to seek treatment before an emergency arises. Further, and perhaps more important, earlier detection and treatment can increase the overall rate of survivorship. What’s not to like about that?


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