For further information, contact:
Mark Richert
Director, Public Policy, AFB
(202) 822-0833
mrichert@afb.net
Reviewing the Chart
The beginning of Congress's August recess is a good time to review where we are with respect to health care reform and our field's policy priorities and to map a clear path of travel moving forward.
Progress in Congress to negotiate complex health care reform has come in fits and starts over the last couple of months. While prominent members and their staff continue to struggle to keep talks moving forward behind the scenes dealing with the decisive macro matters that will determine whether health reform can in fact make it to the President's desk, several key congressional committees have nevertheless kept the momentum moving forward by passing an array of widely varying approaches to health care reform. However, with one small exception, none of these proposals addresses the health care inequities experienced by people with vision loss. Therefore, much more work needs to be done.
Signs of Life: Some Hope for Device Coverage
Our community has united around three health reform priorities: drug label accessibility, wider availability of low vision and other devices, and coverage for vision rehabilitation services provided by appropriately trained vision rehabilitation professionals. To date, only one of these issues has received attention in health care legislation, and even that modest effort falls short.
The version of health reform legislation passed by the Senate Health Education Labor and Pensions (HELP) Committee would require that rehabilitative and habilitative devices be recognized as a mandatory coverage category in a newly-restructured health care delivery system. A House Education and Labor Committee bill was also adopted with a direct reference to mandatory coverage for durable medical equipment, prosthetics, orthotics and supplies, but that bill fails to define those terms of art in a way that ensures inclusion of low vision devices within such coverage categories. As a result, the Senate HELP Committee's approach, while strictly speaking less precise in its terminology, is nevertheless preferable to the House Education and Labor Committee's approach which would essentially perpetuate the status quo categorical exclusion of low vision aids.
Inclusion of the language in the HELP bill was the result of cross-disability collaboration among many organizations including AFB. This broadly worded Senate HELP Committee move to include devices, a coverage category that had not been part of any health reform legislation initially proposed in either chamber, is a small but important victory and may lay the groundwork for further advocacy in the months ahead.
Troubling Complications: Recognition of Vision Rehab Services in a Muddle
None of the proposals currently in play either address Medicare coverage for vision rehabilitation services or Medicare recognition of vision rehabilitation professionals. Some advocates in our field are calling on Congress to support the vision rehab professions by including direct reference to them in provisions of health care legislation currently on the table intended to enhance the health care practitioner workforce. If successful, this alternative effort would establish grant programs, loan forgiveness, interdisciplinary professional development initiatives, and other financial incentives to possibly create additional future funding streams for training of vision rehabilitation professionals. While clearly valuable, such an approach is unrelated to Medicare coverage of the services provided by orientation and mobility specialists, vision rehabilitation therapists, and low vision therapists.
Chronic Conditions: Drug Label Access Adrift
The effort to ensure medication information and label accessibility has been meeting with considerable sympathy on the Hill, but like many other proposals, key Congressional health staff have yet to acknowledge this issue as a legitimate aspect of health care reform. This is so in spite of the fact that many provisions in the various health reform bills run far afield of the central health care reform debate. For example, the Senate HELP Committee bill includes requirements to clearly list caloric and other nutritional information on chain restaurant menus and vending machines.
It has also been argued that drug label access is an Americans with Disabilities Act (ADA) issue and, as such, is already dealt with elsewhere and inappropriate to consider in health reform. This perspective is in error. The ADA does place a general requirement on public accommodations like retail pharmacies to effectively communicate information. However, the ADA does not guarantee that customers will receive medication information access in their preferred medium (e.g., large print, audio, Braille, etc.) and does not prescribe specific standards for retail pharmacies to follow to ensure safety, reliability, and privacy.
The Prognosis and the Prescription: The Message Congress Needs to Hear Now
Each of the three policy priorities our field has endorsed are critical to meet the health care needs of people with vision loss. Even though considerable work has already taken place to move health reform legislation toward enactment, much more work will be undertaken in the months ahead. In particular, Washington insiders predict that the real hard core action will begin once both the House and Senate have passed all of their respective health reform packages because then negotiators from both chambers will need to resolve the inevitable myriad dissimilarities. All of that is simply to say that there is still plenty of opportunity to influence the policy process.
It is, however, imperative that our field's message be clear and consistent. Each of the issues we care about needs to be communicated with commitment. If we elevate one issue over others, we are inviting outright dismissal of those issues we deemphasize.
The August Congressional recess, when members come back home to hear from you, is a great time for advocates to communicate the following message to Congress.
To meet the needs of Americans living with vision loss, health reform legislation must:
ensure that individuals with vision loss and other disabilities can properly identify and take medications by mandating appropriate labeling standards and methods for providing nonvisual and enhanced visual access to drug container labeling and related information;
establish clear Medicare (or other national minimum benefit plan) coverage for, and foster broader private plan availability of, low vision devices and other medically necessary assistive technologies; and
allow orientation and mobility specialists, vision rehabilitation therapists, and low vision therapists to be full participants in the professional team providing specialized services to people with vision loss by establishing unambiguous Medicare (or other national minimum benefit plan) reimbursement for the services such professionals offer
Tell Congress that the vision loss community will not endorse health care reform legislation that fails to address any of these critical needs. We must withhold our formal support for health reform legislation unless and until it passes the test our field has set for it, namely full treatment of each of the three policy priorities to which our field is committed. Half measures and vague language must not be allowed to substitute for the very real changes in health care access and quality needed by people living with vision loss.
