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  • House Passes Health Care Bill That Reduces Patient Access; APTA Takes its Message to the Senate

    The American Health Care Act (AHCA) bill that narrowly passed the House of Representatives will move on to the Senate—and so will APTA's opposition to AHCA provisions that would allow states to reduce or eliminate essential health benefit requirements, including physical therapy.

    Under the AHCA, significant parts of the Affordable Care Act (ACA) would be repealed and replaced with provisions that, among other things, cap and then reduce Medicaid appropriations, eliminate subsidies in favor of tax credits for individuals who purchase insurance through the exchanges, and change "essential health benefit" (EHB) requirements—services that insurance companies must cover no matter what. Under the ACA, rehabilitation and habilitation services such as physical therapy are included in federally mandated list of EHBs, but the AHCA would allow states to apply for a waiver to create their own EHBs or eliminate them completely. The bill passed on a thin 217-213 margin (a good overview of the AHCA can be found at National Public Radio, and The Washington Post has published a useful Q-and-A piece on the bill).

    In a statement issued in March when an earlier version of the AHCA surfaced, APTA President Sharon L. Dunn, PT, PhD, decried the elimination of federally mandated EHBs as part of an overall direction in the AHCA that would "create unneeded barriers to care and reduce the access to care for millions of Americans." That position was reinforced in April, when APTA signed on to a letter to Congress from a coalition of 46 national consumer, clinician, and membership groups opposing the changes to EHBs. The letter stated that "there is little doubt under this scenario that access to rehabilitation services and devices would suffer in many areas of the country."

    The bill will now move on to the Senate, which can change provisions in the legislation or introduce its own version of a health care law, a possibility recently put forward by Sen Lamar Alexander, chair of the Senate Committee on Health, Education, Labor, and Pensions, and echoed by Sen Roy Blunt in an interview with ABC News.

    Justin Elliott, APTA's vice president of government affairs, says that regardless of what takes shape in the Senate, APTA will continue its focus on advocating for a health care law that will ensure affordable access to care for all Americans.

    "APTA is now turning to the Senate to educate members on how including provisions like EHBs not only improves the lives of millions of Americans, but actually reduces overall health care costs," Elliott said. "We want to deliver the message that APTA isn't opposed to reform of the ACA, but that reform needs to align with our policy principles that are rooted in inclusive access to care. Unfortunately, the version of the AHCA approved by the House falls short of those principles."

    Comments

    • We as Physical Therapist need to speak up and advocate for the sick and disabled. We need to be active in the fight to bring affordable quality healthcare to all !

      Posted by Mary Moriarity on 5/5/2017 7:39 PM

    • Physical Therapy is and will be what keeps me mobile and "pain free". Without this service I would be subject to unbearable pain, and a significant lack of mobility.

      Posted by VERONICA FEIGHTNER on 5/6/2017 12:11 PM

    • Reduces access? Where has the APTA been the last 8-9 years in which co-pays and deductibles have skyrocketed and reimbursements continually reduce (multiple procedure reduction). Now that reduces access to physical therapy. Lobbying to put physical therapy as an essential health benefit does nothing when the co-pays are 60 bucks and deductibles are 7000$.

      Posted by Shaun D Spade on 5/7/2017 8:54 AM

    • The APTA works very hard for healthcare in general. Each state also has associations working behind the scenes. They have committees that meet regularly with insurance companies about issues like copays. We as therapist understand how cost is a huge berrier to access. It's the insurance companies and overall medical cost driving the copays. Increasing access the physical therapy is a way to reduce medical cost by improving function and reducing future injury and dysfunction.

      Posted by Hope Cole on 5/9/2017 9:42 PM

    • We can help the opioid epidemic, decrease need for unnecessary surgeries, improve mobility, and help improve quality of life throughout the life-span. I don't understand why we are cutting preventative healthcare. This is the complete opposite direction healthcare needs to go. So sad.

      Posted by Andrew Albright on 5/10/2017 4:03 PM

    • I believe the point in the new bill is to ensure more, not less access overall. I feel for those who will still require Medicaid but I will celebrate the replacement of a system that forces individuals onto Medicaid instead of offering them a viable and affordable alternative. In Florida, AHCA managed plans have already decided to eliminate physical therapy benefits for recipients older that 21. I don't see this new bill as a restriction to care, I see it as expanding the volume of available pt's with more health care options to choose from. This will allow those conservative consumers, our patient's, to choose plans light on prescription medications and surgery and heavy on more conservative care. Please support a plan that offers more people, irrespective of whether they are Medicaid recipients or otherwise. Children and adults with special needs or disabilities are in families irrespective of whether they are lower, middle or upper class socioeconomically. Let's support that bill that helps all these who need help the most!

      Posted by Joe on 5/10/2017 4:03 PM

    • I fully support opposition to the recent bill (AHCA) passed by the house. It is a major setback in providing adequate health care to millions of citizens especially the young, elderly disabled and poor. The bill is meanspirited and reflects greed and selfishness and undermines the concept of health security for us all.

      Posted by John Patrick Mahoney on 5/10/2017 4:27 PM

    • What really restricts access to PT services are FAT premiums with a $10,000 deductible. These people may have an insurance card saying they have PT benefits, but they do no really have insurance coverage. They pay cash. Many see that the current system was a giveaway to payers in many states that invited runaway costs, narrow networks, high deductibles, and few, if any, insurances choices in many states. I don't remember APTA pushing back against the disastrous policies that accelerated this mess that put millions of people on a Medicaid- like program, forcing many of them to go to the ER for care. Many had affordable, catastrophic plans prior to that and saved their money expected care costs. The health insurance is a disastrous, rigged, corrupt system. Auto insurance covers the car wreck, not the oil change.

      Posted by Paul on 5/10/2017 4:31 PM

    • Agree completely with Shaun that past policies have done more harm than good for true access to PT services. There is a big difference between an insurance card and actual insurance that works. It's easy to dump on one political party or the other, but much harder to fix failed health care policy that is not working, as evidenced by high payments/deductibles, can't keep your Doctor of PT, and few to no payer choices in many states. Less partisanship and more professionalism is what we should be expecting from our representatives. Let's think about how things work in the real world a bit more, as well.

      Posted by Paul on 5/10/2017 4:55 PM

    • A brief review of the 2 liberal based resources for questions and answers regarding the ACHA indicates a lot of predictions and speculations. This is why it is hard to trust news sources. I have already adjusted to the decreased volume of insurance covered patients (due to high copays and deductibles) by increasing cash based services. I will continue to prove the worth of PT through exemplary skills, professionalism and community involvement.

      Posted by Julie Bellone on 5/10/2017 6:01 PM

    • EHB requirements are one of the factors that have made health insurance and, more importantly, healthcare cost prohibitive! Allowing greater flexibility and competition in the industry will improve patient access, encourage innovation, and lower cost. It is a matter of concern for me that my APTA membership fee may be working against what I believe is in the best interest of the populace even if it means that we'll have to compete for healthcare dollars. If PT is viewed as a valuable, desirable service, people will search out insurance that covers it! If PT does in fact lower overall cost of healthcare for patients, then insurance providers will want to encourage and include it in covered services in order to lower their overall cost. If congress just stops here, I agree that it leaves a lot to be desired; but it's a start in the right direction. We have nothing to fear from greater freedom and choice!

      Posted by Heidi Yocum, PTA on 5/10/2017 6:11 PM

    • The APTA position statement clearly illustrates how out of touch it is with those seeking, and providing service outside of hospital-based facilities. It also leaves me wondering if there is a clear understanding of the EHB exemption process, and how different states allocate their Medicaid dollars. I agree with the obive opinion regarding exceptionally high deductibles, copays and co-insurance burdens placed on families attempting to access physical therapy services. In many instances, families are essentially paying cash, as their deductible is over $10,000. While doing this, they continue to pay astronomically high premiums. As a private practice provider, I can also tell you that the contractual rate offered by some of the AHCA plans is LESS than what it costs to provide service. This has left many subscribers with an insurance card that very few places will accept. For those families that have special needs children, it has essentially limited their ability to advocate for their child and obtain service from the most qualified provider. Please, I beg you, stop taking sides and start formulating a plan that can contribute to a solution. Overall, we must recognize that most people work exceptionally hard to pay their bills and care for their families. We owe it to them to spend the tax dollars they have so struggled to contribute, with careful vigilance. While doing this, we must also continue to advocate for each person to chose what they desire in healthcare, and obtain it from a qualified provider. In this matter, the APTA position does NOT speak for me.

      Posted by Deirdre McDowell on 5/10/2017 7:52 PM

    • I agree with many of the above positions that simply passing bills that allow ongoing expansion of medicaid and similar programs is NOT the way to go. As noted above, due to low reimbursement levels, if my entire practice was made up of medicaid beneficiaries I would be out of business, or have to downgrade to a small facility with limited staff and work longer hours just to make a decent profit. Anyone in private practice knows this to be true. The real reform needs to be in making physical therapy and healthcare in general AFFORDABLE, NOT JUST ACCESSIBLE. We can see the writing on the wall that as these sorts of bills are passed and more stress is placed on government run insurance plans that reimburse little, providers will become few and far between or get swallowed up by large hospitals, limiting autonomy and quality of care. PLEASE work to make physical therapy affordable, as more and more patients are asking for short (less than 5 visits) episodes of care to manage their costs, no matter their ongoing need for PT. Until cost is managed, access doesn't matter. I have access to Mercedes dealerships but without the ability to pay for that car it really doesn't do me any good!

      Posted by Barry Wrench on 5/11/2017 6:54 AM

    • I fully endorse this bill! We need people to start being responsible for their illnesses! And if they can't pay for their healthcare then it's their own fault since they can't control their body's functions!

      Posted by Don Rump on 5/11/2017 8:38 AM

    • I could not agree more with Deirdre's comments above. The ACA only provided benefits at face value. What good are these "essential health benefits" if a patient cannot afford their deductibles or find a provider willing to take their plan? Those of us in the real world recognize that most individuals on ACA plans see little to no actual benefit. There's a difference between having meaningful coverage and having an insurance card. ACA is crumbling under it's own weight also - as it is not sustainable. Aetna announced just yesterday that they are pulling out. Now, I'm not saying that the newly passed House version of the AHCA has all of the answers either. There are many flaws that need to be addressed. The point, however, is that APTA needs to remain apolitical and not make the same mistakes that the AMA and AARP did by disenfranchising half their membership by "taking sides". Please work together with those in congress on influencing this new plan and making necessary amendments in the Senate - rather than calling for or suggesting opposition. I believe that's what Justin is essentially saying - but some of the messaging that has gone out on social media etc. (the very title of this article, for example) seems very politically-charged and makes broad and not necessarily accurate statements (Example: "House Passes Health Care Bill That Reduces Patient Access"). As someone who cares deeply about our organization, I encourage the APTA to please not make the same mistakes others have made.

      Posted by Daniel on 5/11/2017 9:36 AM

    • The AHCA does nothing to make healthcare more accessible or more affordable. It will allow states to remove essential benefits, like PT, and allow patients with pre existing conditions to be charged outrages prices. The ACA needs to be fixed on some points, but dont throw the baby out with the bath water. This bill is a disaster, and I support the APTA position.

      Posted by JEB ALI ALFAREH on 5/12/2017 2:18 AM

    • In my opinion and experience, the AHCA and the ACA are not the solution to reforming our health care system. Neither addresses the cost of healthcare (which is the issue) nor do they provide better reimbursement rates for PT's. The reality is that due to the strong pharma lobby politicians and insurance companies choose to give out opioids/meds to treat pain/movement dysfunction rather than paying for skilled interventions like OT and PT. Our country is paying the high price for these choices. Additionally, neither reforms Medicaid which is a program that is overstretched and on the verge of collapse. Children with disabilities and their families need Medicaid to absorb the costs of care, DME, etc. I am very concerned that as the program begins to crumble these families will be the first to see a reduction in benefits. I just wish that politics and special interests could be set aside to create meaningful reform. We are back to the drawing board again which hopefully will result in a new direction away from the mistakes of the ACA and the AHCA.

      Posted by CT on 8/2/2017 12:52 PM

    • MEDICARE FRAUD AND ABUSE IS THE PROBLEM WITH MEDICARE. THAT IS INEXCUSABLE BY LITTLE OR NO SUPERVISION BY THOSE BEING PAID TO STOP IT. GOVERNMENT WROKERS ARE LAZY AND EASY TO BE WITNESSED FIRST HAND, IF YOU "CARED ENOUGH" TO LOOK BEFORE VOTING ON THIS ISSUE . PLEASE DONT PUNISH ME FOR GOVERNMENT OVERSIGHT AND ACCOUNTABILITY NEGLIGENCE. Please consider my example, as senior I have osteoarthritis which is on a severe degerative course that REQUIRES me to be in/out of PT to keep me mobile, productive and out of hospital and other more expensive services. However, in addition, I require PT for hip and knee replace surgeries, also. For example, this very day(1-30-2018), for no known, I was struck with excruciating frozen shoulder. In addition to 3 ultrasound strategically located injections to relieve the immediate pain. This must be followed up with 4-5 weeks of aggressive Therapy to unfreeze my shoulder and avoid surgery......which, of course, would exceed the cost of any therapeutic treatment. Medicare should provide ALL minimal care to Seniors like me who have paid our part, and more, for working 40 years and more. AGAIN, I REPEAT, WE SHOULD NOT BEAR THE BRUNT OF LIMITED REQUIRED SERVICES DUE OF FAILURE OF THE AGENCY TO RADICALLY REDUCE MEDICARE COSTS BY EFFICIENT, AUTHENTHIC SUPERVISION AND SWIFT PROSECUTION WITH SIGNIFICANT PRISON TIME THAT WOULD DETER ABUSERS. WHY IS THAT SO DIFFICULT FOR YOU TO UNDERSTANDS? IS IT TRUE THAT YOU ACTUALLY JUST DON'T CARE ABOUT ME, AND THE REST OF US, WITH EQUAL VIGOR THAT YOU CARE ABOUT SECURING YOUR ON NEEDED SERVICES??? HAVE YOU COMPLETELY LOST YOUR SHAME TO THE DETRIMENT OF YOUR SOUL? DOES LOOKING INTO YOUR MIRROR AND ANSWERING THAT QUESTION NO LONGER SOBER YOU? ONLY YOU AND THE ONE WHO KNOWS YOUR EVERY THOUGHT KNOWS!!!

      Posted by Marcia Chapman on 2/8/2018 5:37 PM

    • It is so incredibly important for health care companies to cover physical therapy right now. The opioid epidemic is absolutely taking over our country, every age group and demographic is being affected by this growing issue. Treatments like physical therapy, acupuncture or medical cannabis are the only things we currently have to save patients with chronic pain from an addiction that can be fatal. However, the government doesn't feel that these alternatives need to be accessible to those suffering... interesting.

      Posted by KJ on 4/2/2019 3:51 PM

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