Many of the two million Americans who are amputees - including military veterans, accident victims, and older Americans - could lose care and the mobility and liberty that comes with that care if federal health care reform is not crafted to avoid three key "pitfalls," according to the American Orthotic & Prosthetic Association (AOPA) and the Amputee Coalition.

As outlined by the groups in a recent news conference, the "big three" priority issues for amputees are as follows: (1) no cuts to Medicaid that would turn back the clock on the limb-loss/mobility impaired community in terms of access to needed treatment and state-of-the-art devices; (2) no waivers as to rehabilitative and habilitative services (an essential health benefit) that could be used to deny access to care and treatment for amputees; and (3) no changes to authorize higher premiums with respect to amputation as a pre-existing condition that could interfere with coverage access. (See details below.)

AOPA President Michael Oros said: "For amputees, loss of affordable health insurance not only means a loss of care, it also means a loss of independence and liberty in the form of the mobility that the care makes possible."
Dr Jeff Cain, head of advocacy program of the Amputee Coalition, a Denver physician, and former president, American Academy of Family Physicians, said: "Arms and legs are not a luxury ... I have three concerns about the current health care reform that could severely limit people with amputations: #1) If fewer people have insurance, fewer people can afford health care, and that means fewer amputees will be able to afford a leg to stand on ... second, not mandating essential health benefits, including habilitative and rehabilitative services, would mean that the cost to insure those people would rise dramatically. If you can't afford an insurance policy, you can't afford a leg to stand on ... and third, we cannot afford to go back to the pre-ACA world of pre-existing conditions, which prevented amputees across the country from being able to afford a leg to stand on."
More details about the three areas of concern for AOPA and the Amputee Coalition are detailed here:

* Medicare cuts. Orthotics and prosthetics provided through Medicaid to millions of individuals are at risk within the current framework of healthcare legislation reform. In 2013, around the time the Medicaid expansion was in full effect, the recorded number of amputations (upper and lower extremity) was 154,000 and 14% of those where paid by Medicaid as compared to 18% by private payers. Since the majority of amputations are between the ages of 45-64, the time before someone becomes eligible for Medicare, and the fact that not all private payers cover prosthetics, the loss of Medicaid expansion could be detrimental to patients facing limb loss and already suffering from limb loss.

* Essential health benefits. Removing of certain essential health benefits from insurer plans may cause individuals to face the possibility of not having coverage for orthotics and prosthetics (bracing and artificial limbs), or be faced with unrealistic annual limits or artificial lifetime caps. Orthotics and prosthetics are considered an essential health benefit under the rehabilitative and habilitative services and devices category; in part because it was included in 70-75 percent of private payer plans. If essential health benefits are removed we could return to 25-30% or more of private employer plans not covering orthotics and prosthetics, and possibly even an increase in the number of non-employer based plans not including O&P coverage.

* Pre-existing conditions. Amputations which are traumatic or caused by an accident, may not always be considered a pre-existing condition, however if the amputation and all follow-up care is required as a result of a disease (non-traumatic); then it could be considered as a pre-existing condition. For example, diabetes may be curable but can also be a long-term illness and lead to an amputation; and cause insurance companies to declare the amputation as a pre-existing condition. A large number of individuals have been affected by the burdens caused by diabetes, in 2010 29.1 million individuals were diagnosed with diabetes and in 2010 60% of non-traumatic lower-limb amputations among adults were attributed to people with diabetes. There are also several conditions (e.g. cerebral palsy or multiple sclerosis) currently listed as pre-existing, and life lasting, which may result in some type of limb impairment and require the use of an orthosis.