We Can Help Californians With Disabilities Keep Their Jobs, Live Full Lives, and Avoid Hospital Stays By Passing SB 1198

By Mary Lou Breslin

If you need heart by-pass surgery, private health insurance will cover the $20,673 average cost for this procedure in the U.S. But if, like me, you had polio as a child and the motorized wheelchair you use has worn out, chances are that same insurer will be among an estimated 90% in California that have imposed an annual cap of $2,000 on what’s called “durable medical equipment” or DME. That won’t buy me a new chair and, like most people with disabilities, I’m not independently wealthy. So I keep my old chair going with a wish and a prayer, and hope that I’m not in the middle of a busy intersection when it finally bites the dust.

DME includes not only manual and motorized wheelchairs and scooters, but also assistive breathing devices, walkers, electric beds, and an array of other home health aids that permit people to live in the community, maintain employment, avoid debt, and stay healthy.

A similar benefit limit also existed for prosthetics and orthotics until 2006, when the California legislature enacted a law that prohibited private insurance caps for devices needed by amputees and others with orthopedic impairments.

Now people with a broad range of physical disabilities are pushing for another change in insurance law, because most people who need medical equipment simply cannot afford to pay its high cost. Medicare and Medi-Cal pay for DME, but to qualify for these public programs, many who have private insurance would be required to quit their jobs—surely not a progressive outcome for California.

In February, Senator Sheila Kuehl (D–23rd District) introduced SB1198 to amend the Health and Safety Code and the Insurance Code with regard to health insurance reimbursements for DME. Sponsored by the Disability Rights Education and Defense Fund and Protection and Advocacy, Inc., the legislation mandates that private health insurers offer coverage for DME and prohibits this coverage from including an annual benefit limit. Lifetime benefit limits would remain as would co-pays and deductibles.

This is good legislation on many counts and will cost very little to implement.

The California Health Benefits Review Program (CHBRP) conducted an independent analysis concluding that the bill would entail a minimal premium increase of no more than 0.7%.

Comments

Posted by: BA Haller at August 6, 2008 02:03 PM

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