RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with Disabilities

Laura Remson MitchellLegislative Coordinator

Member of the Executive Committee

California Disability Alliance

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Copyright 2003 by Laura Remson Mitchell.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Key Disability-Related Health-Care Issues

Most problems fall into following categories: Focus on cost-containment Accessibility of care Access to affordable health coverage Delivery of covered benefits Benefits design/definition of medical

necessity

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Focus on cost-containment

Threatens benefits Examples:• Medi-Cal benefit cuts, eligibility• Medicare restrictions• Restrictions/cutbacks on covered benefits in

private sector

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Focus on cost-containment Important Buzz Words

• “Cost-effectiveness”Biggest bang for health-care buck.

• Good if goal is best care for individual patients.• Bad if goal is primarily cost-containment and

based on total patient population.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Focus on cost-containment Important Buzz Words

• “Evidence-based medicine”Requires scientific evidence to justify treatments.

• If done right (allowing other standards when evidence doesn’t exist), this could improve quality of care.

• If goal is just cost-cutting, lack of scientific evidence could be used as excuse to deny effective care for people with disabilities as well as those with rare or unusual conditions.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Accessibility of care

PhysicalBuildings, equipment, etc.

Programmatic Examples: Educational programs, information, grievance/appeal procedures

CommunicationInterpreters (ASL and other), materials in alternative formats, etc.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Access to Affordable Health Coverage

Losing coverage Aging out, earning out, being priced out, etc., leaves many people with disabilities vulnerable.

Risk-avoidance by health insurers and providersInsurers, health plans, hospitals and some other health-care providers often find subtle ways to avoid people with disabilities when they can’t deny coverage outright.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Access to Affordable Health Coverage “Mitchell’s Corollary”:

In the absence of a level competitive playing field, bad health plans tend to drive good plans out of business. • Plans that are good for people with disabilities

attract high-cost patients, while bad plans are able to reduce costs by avoiding us.

• Result: Bad plans can offer lower premiums and take profitable business away from good plans.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Access to Affordable Health Coverage

Universal Coverage and Disability• Universal health coverage could spread the risk

and put an end to cost-shifting and risk-avoidance.• We must evaluate specific proposals carefully,

then advocate to make them disability-sensitive and to assure an ongoing role for people with disabilities in running the system.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Delivery of covered benefits

Barriers to care• Procedural issues (created by insurers, health

plans and administrators of publicly funded plans)• Accessibility issues• Geographical/transportation issues

Choice of providers • Access to specialty care

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Delivery of covered benefits

Disability stereotypes• May affect willingness of some providers to deliver

certain services (like preventive care).• May diminish health-care provider’s ability to

recognize/treat health problems unrelated to patient’s disability.

Grievance/Appeals procedures • If system isn’t accessible, it’s tough to fight back!

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Benefit design/definition of medical necessity

Disability-insensitive benefit designExcludes or unreasonably restricts items and services that people with disabilities need to live independent lives. Reflects black-or-white thinking about disability.• Example: Medicare covers durable medical

equipment (DME) only if needed in the home, not if needed in the community.

• Example: Failure to recognize and cover so-called “maintenance therapy” as preventive care.

RespectAbility ConferenceOct. 3-4, 2003

System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance

Benefit design/definition of medical necessity

Medical-model view of “medical necessity” Focuses on “cure” or measurable physiological improvement.

Disability-sensitive viewRecognizes “maximizing functional independence” as essential part of “medical necessity,” whether that involves improving physiological function or providing

appropriate assistive items and services.