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Tuesday, September 7, 2010

Expert Q&A: I have a disabled daughter

Elaine Saly

Health Policy Analyst

Many of you have sent in questions about how the new health care law will affect you and your family. We’ve compiled answers for select questions to our experts in a short series to help you navigate changes to the health care system. Here's the latest: 

Question: I am a single mom with a severely disabled daughter and have great concern about "rationed" health care affecting the most vulnerable people in our society; i.e., the elderly and disabled.  Please discuss how reform will not adversely affect this population.

Answer: The new law will not ration care for people with disabilities or the elderly, or anyone else. In fact, the law will address many of the current barriers that people with disabilities and seniors face in getting health care by establishing a number of programs to broaden the availability of long-term services and supports and banning discriminatory insurance company practices.

Some concerns about rationing under health reform have stemmed from myths about how Medicare enrollees will be affected by changes to the way that health care providers are paid or health care services are delivered. The new law does not reduce Medicare’s guaranteed benefits. In fact, it improves Medicare’s coverage by increasing coverage for primary care services and making prescription drugs more affordable. It also aims to improve the quality of care for people in Medicare by promoting collaboration among health care providers and eliminating waste and fraud in the health care system. Important measures to make sure that Medicare stays financially stable, such as reducing overpayments to private insurance plans that are selling policies through the Medicare Advantage program, will not diminish access to any of Medicare’s guaranteed benefits. Instead, these changes will encourage high-value, high-quality plans to participate in the program.

Although many seniors and people with disabilities receive health coverage through the Medicare program, others have found that the Medicaid program, traditionally for low-income people, is the only source of coverage for the long-term supports and services they need. The new health reform law includes several programs that give state Medicaid programs more federal funding to deliver these services in community-based settings, like people’s homes, rather than in nursing homes or other institutions. The law also establishes a voluntary insurance program, Community Living Assistance Services and Supports (CLASS), which provides a cash benefit to help people afford community-based long-term services without exhausting their financial resources.

The law also helps people with disabilities and seniors in the private insurance market. It prohibits insurance companies from denying coverage to people with pre-existing conditions, starting this year for kids and in 2014 for everyone. It also prohibits insurers from charging higher premiums to people based on their health conditions, starting in 2014.

There are many myth-makers out there trying to convince people that health reform will ration care. However, the truth is that health reform makes important improvements to our health care system that will provide seniors and people with disabilities better access to comprehensive health coverage and to the care they need in community-based settings. All this while guaranteeing continued access to the benefits that have worked well for them in their current private insurance plans, Medicare, or Medicaid.