Academic journal article The Journal of Rehabilitation

Disability and Health Care Reform: Principles, Practices, and Politics

Academic journal article The Journal of Rehabilitation

Disability and Health Care Reform: Principles, Practices, and Politics

Article excerpt

The magnitude of change in health care policy within the United States is parallel to the evolution of computer technology during the last decade. The changes have been swift, extensive, radical, and unprecedented. The reform in health service provision has completely reshaped the landscape of medicine and the allied professions. Persons with disabilities have not been spared the effect. For example, public funded medical providers such as Medicare, Medicaid, and worker's compensation are increasingly being privatized through contractual agreements between the states and health care providers (Hagglund & Frank, 1996). Oftentimes, these agreements result in economic limits on services for recipients such as persons with disabilities.

The aforementioned change in health care policy is being fueled by the public and private sector's concern for cost control. Private industry has experienced double-digit inflation annually in the cost of employee health benefits. Kongstvedt (1989) stated that corporations have addressed the escalation in cost by reducing coverage and/or offering creative benefits packages such as managed care arrangements (e.g., health maintenance organization [HMO], preferred provider organizations [PPO], and independent practice associations [IPA]). Rising cost for local, state, and federal agencies has been more rapid than in the private sector. Treatment cost at county clinics and hospitals have encouraged both the state and federal government to consider reducing payments to physicians, increasing premiums paid by Medicare beneficiaries, allowing states greater control over Medicaid, and persuading enrollment in private sector managed care plans (Bellamy, 1995). Although passage of a comprehensive reform package failed in the 104th Congress, states such as Oregon and Tennessee have made major reforms by focusing on managed care. According to Cavaliere (1995), at least twelve states have been granted 1115(a) waivers from the Health Care Financing Administration (HCFA). The waivers enable the states to mandatorily enroll Medicaid recipients in managed care service delivery systems.

The significance of adequate health care coverage for all Americans is indisputable. However, it is particularly crucial for persons with disabilities because of special health care needs, greater risk for higher health care costs, and tougher approvals for private insurance coverage (Reno, 1994). Uninsurance and underinsurance is a prevalent and severe problem for persons with disabilities (Watson, 1993). Although the common belief is that Medicare and Medicaid cover all persons with disabilities, nearly 16 percent (2.1 million) of working-age individuals in 1984 with an activity-limiting disability had no insurance (Watson, 1993). A typical private health insurance plan covers acute care hospitalization and physician expenses, yet it rarely provides for long-term needs such as medical equipment, supplies, rehabilitation, or personal assistance services. Watson (1993) reported that in 1991 a woman with multiple sclerosis indicated in testimony to the National Council on Disability that she spent $8,000 of her $20,000 annual salary on health-related needs, even though her full-time employment provided health insurance. The perceived importance of medical coverage for recipients of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) is so great that the risk of losing coverage is a larger rehabilitation disincentive for employment than is the loss of their cash benefits (Quinn, 1995). Thus, secure medical coverage for persons with disabilities is paramount to developing stable health care policies that facilitate entry or return to employment following rehabilitation.

Watson (1993) noted that persons with disabilities have been conspicuously absent from the debate regarding health care, yet they have much at stake. Moreover, many of the conventional proposals of reform ignore the varied and group specific needs of persons with disabilities. …

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