ASHA Issues Seven Health Care Positions Several provisions of proposed health care reform legislation could have severe and critical impacts on people seeking help for communication disorders. In response, the ASHA Board of Directors approved seven health care policy positions to guide advocacy on any future attempts at health care reform. The positions add to and ... Policy Analysis
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Policy Analysis  |   June 01, 2017
ASHA Issues Seven Health Care Positions
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   June 01, 2017
ASHA Issues Seven Health Care Positions
The ASHA Leader, June 2017, Vol. 22, 26-27. doi:10.1044/leader.PA2.22062017.26
The ASHA Leader, June 2017, Vol. 22, 26-27. doi:10.1044/leader.PA2.22062017.26
Several provisions of proposed health care reform legislation could have severe and critical impacts on people seeking help for communication disorders. In response, the ASHA Board of Directors approved seven health care policy positions to guide advocacy on any future attempts at health care reform.
The positions add to and enhance the association’s 2017 public policy agenda. Each provides greater specificity and allows ASHA to proactively respond to the array of health reform proposals under consideration by Congress and by two important regulatory agencies: the Department of Health and Human Services and its Centers for Medicare and Medicaid Services.
These seven policy statements indicate ASHA’s resolve to protect access to care and to maintain and expand coverage of audiology and speech-language pathology services in any reform efforts.
Oppose federal block grant and per-capita caps on federal Medicaid spending. Audiology and speech-language pathology services are optional for adults over 21 under the Medicaid program. Medicaid block granting proposals—which would limit federal Medicaid funding to a set amount each year regardless of changes in enrollment—are estimated to reduce federal and state expenditures on health care by as much as $880 billion over 10 years. Provisions in several pieces of legislation in the House would implement block grants and caps that discourage enrollment and comprehensive coverage while promoting more restrictive coverage and eligibility criteria.
Protect the federal Medicaid Early, Periodic Screening, Diagnostic and Treatment (EPSDT) mandate. Children with developmental disabilities and other conditions receive audiology and speech-language pathology services through federal EPSDT requirements. But some House Medicaid proposals—including block grants and those that give states flexibility to design their plans—call for elimination or relaxation of federal requirements. ASHA opposes any relaxing or elimination of EPSDT.
Protect school-based reimbursement from Medicaid for medically necessary services that are also educationally relevant. Under recent House proposals that reduce Medicaid spending, school-based reimbursement from Medicaid for medically necessary services that are also educationally relevant would be threatened. These proposals give state Medicaid agencies limited funds and would, as a result, discourage coverage for school-based services. School districts would still be required to comply with the regulations of the Individuals With Disabilities Education Act (IDEA)—including the requirement to ensure a free and appropriate public education to all students—but without Medicaid funding. Under this scenario, the amount of services available to eligible children under IDEA would drop significantly, threatening students’ access to essential services. These proposals potentially jeopardize positions in schools for providers.
Oppose Medicare vouchers, tax credits and premium support to protect the affordability of care for older Americans and people with disabilities. Recent House discussions of privatizing Medicare, providing vouchers for consumer choice, and establishing tax credits for seniors to purchase health care of their choice threaten the health of older adults. Many seniors live in or near poverty and lack resources to buy health insurance on the open market: In 2013, according to the U.S. Census Bureau, half of all Medicare beneficiaries had individual incomes of less than $23,500 per year. An overwhelming number of retired Americans and people with chronic conditions and disability determinations do not earn enough to pay any federal taxes and, therefore, would not benefit from a credit: By age 70, more than two-thirds of seniors do not earn enough to pay federal taxes, a percentage that increases sharply with increasing age, according to the Center on Budget and Policy Priorities, a nonpartisan research and policy institute.
Oppose increased Medicaid cost-sharing and implementation of high-deductible health plans for low-income Medicaid beneficiaries. As with similar Medicare proposals, Medicaid initiatives to increase co-payments and co-insurance for beneficiaries—implemented in some states and proposed by Congress—fail to recognize the limited financial resources of many people and families enrolled in Medicaid. Health savings accounts and high-deductible plans can focus consumer attention on health care costs, quality and effectiveness, but people who can’t afford the co-payments may delay or avoid treatment that could help manage and prevent progression to more serious and expensive-to-treat conditions.
Oppose sale of interstate health plans that threaten consumer protections and state mandates for coverage of audiology and speech-language pathology. All states license health insurers that sell policies within their borders and regulate the health plans sold there, including rules about the benefits insurers operating in their state must offer. Under interstate health plan proposals, a plan licensed in one state could sell coverage to residents of another state in which the plan is not licensed or regulated. This process would skirt state insurance-commission regulations designed to protect consumers and hamper state commissions’ ability to enforce provider licensure laws—which ensure that only qualified, licensed professionals are providing health care. Cross-state coverage would make it impossible to enforce state-based laws that mandate, for example, coverage of autism treatment, habilitation services, hearing health care, telepractice and co-payment parity for mental health services.
Enact consumer protections for access to affordable, quality care, including habilitation services, before repealing the ACA. One of the hallmarks of the ACA is the essential benefits package, which ensures patient access to quality health care for a comprehensive list of specific categories. One of those categories is habilitation services, which help people with developmental delays and congenital disorders develop and acquire a wide range of skills. (They differ from rehabilitation services, which help people regain skills after illness or accident.) Habilitation services are particularly at risk in ACA-trimming plans because they were not usually included in private health plan coverage before the ACA was passed. Access to and coverage of habilitation services is critical for many people who need hearing and speech-language services.
With these positions, ASHA has direction on how to respond to health care reform proposals across the range of settings where health care decisions are being made—from Congress and federal agencies to state legislatures and governors’ offices—and proactively advocate for coverage of and access to audiology and speech-language pathology services.
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June 2017
Volume 22, Issue 6