Health Care Reform Implementation
President Obama signed the Health Care Reform package in to law in March 2010, which will extend insurance coverage to as many as 32 million Americans who currently do not have health insurance, as well as provide much-needed protections for people with lupus and other chronic conditions. The law will not be implemented all at once. Below is a timeline showing the provisions that will be most beneficial for people with lupus and when they will commence. For the full list of changes and protections included in the Health Care Reform law, visit www.healthcare.gov.
LFA Health Care Advocacy Initiatives
The Affordable Care Act includes many important provisions for people with lupus, yet there are some concerns for people with lupus that were not addressed by the legislation. The LFA is continuing ongoing comprehensive initiatives to educate Members of Congress on health care issues that are important to people with lupus that were not in the Affordable Care Act. Our efforts include the following:
National Coalition on Access to Medication
The LFA is leading a national coalition of disease-specific organizations to address certain issues that people with lupus and other chronic conditions may encounter regarding access to medication, such as high co-pays for drug treatments.
Cap Out-of-Pocket Copayments
The LFA commissioned a study that outlined the discriminatory practice of putting newer drugs on higher tier levels which have made access to these drugs unaffordable. LFA and its partners are distributing this report to Members of Congress to help them better understand and support legislation that will put a maximum cap on the out-of-pocket costs beneficiaries will be required to pay for their medications.
Meetings with Members of Congress
Actively engaging federal officials at all levels to discuss the unique medical needs of people with lupus and recommend solutions. For example, LFA staff continues to communicate to health policymakers that comparative effectiveness research on many chronic diseases, such as lupus, should not focus solely on cost, which could ultimately become a barrier to treatment. Instead, the physician should have the ability to consider the patient's unique diagnosis and prescribe treatment accordingly that will have the greatest impact on the patient’s quality of life.
Improving Access to Social Security Disability Benefits
The LFA works with the Social Security Administration to revise the appeals process to make it easier for people with lupus and other chronic diseases to provide documentation in a reasonable timeframe to prove the severity of their condition. LFA is hopeful that this will lead to more people receiving Social Security Disability benefits.
Training local and state advocates to share with their Members of Congress the health priorities of people with lupus during local Town Hall meetings and state advocacy days.
Waive the 24-month Medicare disability waiting period
People under 65 eligible for Social Security Disability Insurance (SSDI) are eligible for Medicare Part A benefits only after a 24-month waiting period (*not applicable to people with end-stage renal disease). Approximately 1.5 million disabled Americans are currently without health insurance due to this waiting period. Many individuals with lupus apply for SSDI because of the disabling nature of their symptoms. Waiting for 24-months for coverage to begin can delay treatment and result in worsening of symptoms and serious health consequences.
Coverage for off-label prescription drugs
Many of the valuable lupus treatments prescribed are used “off-label,” meaning they have not been approved for lupus but are helpful in relieving symptoms. Some health plans will not cover off label use. It is imperative that insurers cover these medications for people with lupus. Contact Congress Today about the Off-Label Parity Act!
Kaiser Family Foundation: http://healthreform.kff.org
Share Your Story
Please share your story with us regarding how you think Health Care Reform will help you. We'll share your story with Members of Congress so they will know how important this law is to people with lupus.