Harkin — The Benefits of Health Care

Dear ABILITY Readers,

The new health reform law, signed by President Obama last month, includes provisions that offer important new protections and choices for individuals with disabilities. These provisions—for which I fought very hard— include, for example, prohibitions on denying insurance coverage based on pre-existing conditions, increased access to home and community-based services, and new standards for accessible medical equipment.

Denial of insurance coverage based on a pre-existing condition has long been a major problem for many individuals with disabilities and their families. That’s why the Patient Protection and Affordable Care Act, when fully implemented, will expressly prohibit insurers from denying individuals health insurance coverage due to a pre-existing condition. It will also prohibit charging individuals with pre-existing conditions higher premiums or excluding them from coverage for specific conditions. In addition, health insurers will be prohibited from excluding children from coverage based on preexisting conditions.

The new law also creates alternatives to long-term care programs that will give individuals with disabilities greater opportunities to remain in their homes and communities. These two new programs, the CLASS Act and the Community First Choice Option, help fulfill the promise of the Supreme Court’s decision in Olmstead by ensuring that individuals with significant disabilities have access to home and community-based services and supports.

The CLASS Act is a voluntary insurance program that provides an affordable way for middle-class families to plan for the possibility of future disability or chronic illness. The program provides participants who have a significant impairment a cash benefit to pay for home assistance, transportation, or other essential services that allow individuals to live in the community rather than in more restrictive setting.

The Community First Choice (CFC) option, based on the Community Choice Act, is a new Medicaid program that will provide home and community-based services to individuals with disabilities—services that are critical in allowing people to remain in their homes and communities and to lead independent lives.

Ten years ago, in the Olmstead decision, the Supreme Court held that the Americans with Disabilities Act (ADA) gives individuals with disabilities the right to live in the least restrictive environments and to make their own choices to receive their care in a community rather than in an institutional setting.

Under current law, Medicaid is required to pay for nursing home care for an individual with a disability who is financially eligible and who has an “institutional level of need.” However, a state has no similar obligation to pay for the same person to receive care at home. This renders the promise of the Olmstead decision hollow for the residents of many states.

The CFC option will, for the first time, require states that choose to participate to provide all eligible individuals with personal care services, rather than serving only a small proportion of the eligible population while maintaining long and slow-moving waiting lists.

CFC is an option within the Medicaid program, and each state will need to make a decision whether or not to opt in. However, states that commit to the CFC option will receive enhanced federal matching funds. This is a very significant investment at the federal level to providing individuals with significant disabilities the choice of remaining in their communities.

The CFC option requires states that choose the option pay for personal care services to help with activities of daily living—such as dressing, bathing, grooming and eating; and help with activities such as shopping, chores, meal preparation, and finances. Readers of ABILITY know very well that this assistance can make a crucial difference in allowing individuals to live independently in a community.

The Act also includes an extension through 2016 of the current Money Follows the Person program, another one of my legislative initiatives, which supports individuals with disabilities who want to move out of institutional settings and back into their own communities. The program provides enhanced financial support and systems change to allow these individuals to do so, with the Medicaid funds “following” the individuals back into the community, to pay for their necessary services and supports.

Finally, the new law—borrowing from my Promoting Wellness for Individuals with Disabilities bill—includes important provisions regarding accessible examination and diagnostic equipment. A major ongoing barrier for patients with disabilities is the lack of accessible examination tables, weight scales, and mammography machines or other diagnostic equipment for people with mobility or balance issues. Under the new law, the Access Board will help develop standards as to what constitutes accessible medical equipment for patients with disabilities.

These new initiatives represent significant progress in our health care and long-term care systems for people with disabilities. They encourage and enable independence, which is what all people with disabilities want. You can be sure that, as chair of the Senate’s health committee, I will continue to make it a priority to ensure that we fulfill the great goals of the Americans with Disabilities Act: equal opportunity, full participation, independent living, and economic self sufficiency for all Americans with disabilities.

We will not give up!



Senator Tom Harkin

Senator Tom Harkin (D-IA) is Chairman of the Senate Health, Education, Labor and Pensions Committee.

Articles in the Regina Hall Issue; Humor — Time’s A-Wastin’; Harkin — The Benefits of Health Care; Ashley’s Column — From Italy, With Love; NBC Diversity Showcase — The Peacock’s True Colors; Chris Waddell — Pretty Tough Guy; Beyond the Chair — Hangin’ with Drew’s Crew; ABILITY House — New Place Like Home; Winter Paralympics — A Snowy Sports Report; Children’s Mental Health — The Doctor Is In; Amy Roloff — Cruising for a Cause; Sarah Reinertsen — Excerpt from In a Single Bound; Regina Hall — Acting, Altruism and a Death at a Funeral; ABILITY Awards — We Like You, We Really Like You; Andrea Friedman — Sarah Palin and the Family Guy Feud; EEOC Bad Boys — Schooling the Employers; ABILITY’s Crossword Puzzle; Events and Conferences…


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