Editorial Report: Health Care Reform

Article excerpt

Since its introduction in September, we have reported regularly on the progress of President Clinton's health care reform proposal. We have received many letters urging us to continue these reports. We also have heard from a number of parents who shared their concerns--based on various reports--that children with disabilities may be shortchanged under the currently proposed plan. In December, for example, the Associated Press reported on a hearing during which members of the Senate Finance Committee had acknowledged that children with "birth defects or chronic health problems could be excluded from coverage under President Clinton's plan..."

In reviewing the following reports and commentaries, it is essential to remember that--despite perceived inadequacies-the President's proposal offers major reforms that vastly improve many aspects of the current health care system.

Current concerns

Two specific gaps in coverage for children with disabilities have been identified---outpatient rehabilitation services and "customized" durable medical equipment. The proposal's coverage for outpatient rehabilitation services emphasizes the restoration of physical or intellectual functioning following "illness or injury." Accordingly, it appears to omit long-term, outpatient services that many children with disabilities require to maintain current abilities and prevent future problems. Such outpatient services might include physical therapy, occupational therapy and speech and language therapy. Administration officials agree that this is an issue and have urged concerned citizens to contact members of Congress to advocate for the necessary coverage.

"Durable medical equipment" includes seating systems, wheelchairs and many other products. The health reform plan appears to cover "durable medical equipment" and "prosthetic and orthotic devices," while "customized devices" are excluded. Limiting coverage to "off-the-shelf" equipment presents a problem since devices for children are often customized--or individualized. Current health insurance coverage typically has similar limitations requiring parents to pay the difference in cost between the "generic" and "customized" versions of a product. This difference in cost, however, can be substantial.

Knowledgeable advocates have raised additional questions about how other services for children with disabilities will be covered. These include Medicaid payments for early intervention services, so-called "related services" such as therapies within special education programs, and EPSDT (Early and Periodic Screening, Diagnosis and Treatment) services. Concerns have also been raised about coverage for home care and community-based services for people with severe disabilities. Though the reform proposal includes some important services of this kind, it allows individual states to place restrictions on eligibility and types of services provided.

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