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The Alliance’s Oppostion to Senate Bill 1055: The Health Insurance Market Modernization and Af

To: United States Senate

Washington, D.C.

Attn: Health LA

Re: Opposition to S. 1955: The Health Insurance Market Modernization and Affordability Act

Dear Senator:

The Orthotic and Prosthetic Alliance, a coalition of the four primary organizations engaged in the provision of quality orthotic and prosthetic care (orthopedic braces and artificial limbs), favors legislative solutions to increase access to affordable health care coverage, especially for small businesses. We strongly believe, however, that S. 1955, the “Health Insurance Market Modernization and Affordability Act,” is not an approach that will achieve this goal. To the contrary, we believe that S.1955 will lead to a net loss of coverage of medically necessary orthotic and prosthetic services and higher premiums for quality health care insurance.

There is little debate about the medical value of orthoses and prostheses. For example, diabetes, obesity and the effects of aging are becoming major drivers of orthotic and prosthetic services—which offer the best hope of continuing future quality of life. Nevertheless, because orthoses and prostheses are often relatively expensive and only serve a comparatively small percentage of the population, many insurers choose to minimize costs by excluding coverage for this benefit. Furthermore, when purchasing insurance, individuals rarely anticipate the possibility of a lost limb and may easily forsake such a coverage benefit in exchange for slightly lower premiums. When unfortunate circumstances do occur and an individual loses the function of a limb, it may be too late to obtain affordable insurance coverage that covers the orthotic and prosthetic care they need.

A number of states already have recognized the importance of this care and have enacted legislation requiring coverage of these needed services, particularly prosthetic services. Such legislation ensures access to medically necessary prosthetic care among the privately insured population. It also ensures that consumers are not unduly penalized for failing to anticipate the possibility of a lost limb. Furthermore, when states require coverage of prosthetics, the costs of such services are distributed across the largest possible population, equating to very modest increases in cost to those with private insurance.

S. 1955 would reverse the progress that has been made in many states with respect to coverage of prosthetics and would lead to decreased access to such medically necessary services. Small Business Health Plans would be entirely exempt from any state laws mandating orthotic and/or prosthetic benefits. Accordingly, an insured individual in such a plan risks extremely high out-of-pocket costs should the individual lose the function of a limb and require orthotic or prosthetic care.

Similarly, under S. 1955, all health insurers would be free to create ‘basic option’ and ‘enhanced option’ health plans. The basic option plan would only need to meet a minimum set of federal standards; it would not need to satisfy any state benefit requirement. Potentially, such a basic option may exclude coverage of orthotic and prosthetic services. Health insurers that offer such a basic option would also have to offer an ‘enhanced option’ that is based on the set of benefits from one of the five most populous states. Because not all five of the most populous states require coverage of orthotic or prosthetic services, an insurer could choose to forego coverage of orthotic and prosthetic care in the enhanced option as well.

The enactment of S. 1955 could increase the number of ‘underinsured’ individuals in this country. Employees of small businesses may have greater access to insurance overall, but would not be afforded the protections of state law with respect to whether such insurance would cover vital and medically necessary services, such as orthotic and prosthetic care. With respect to other insurers, insurance sponsors would be free to create plans that offer a low premium in exchange for minimal benefits.

Such minimal plans would be most attractive to the healthiest portion of the population, leading to higher premiums for everyone else. With respect to prosthetic services, this means that healthy individuals—who remain at risk of losing a limb due to an accident or disease—will find themselves without coverage should the need for a prosthesis arise. The less healthy and older population will be forced to pay higher premiums, leading to quality health care coverage becoming increasingly unaffordable to those who need it the most. Individuals who already use prostheses in conducting their daily activities of living may find themselves unable to continue to afford a plan that sufficiently covers such a benefit.

We urge you to oppose S. 1955. Opposing this legislation will ensure that states may continue to protect vulnerable portions of the population, such as individuals in need of orthotic and prosthetic care and will ensure that quality health care coverage does not become even more unaffordable due to the offering of low-price, low-quality health insurance.

Thank you for your consideration of our concerns. If you have any questions, please feel free to contact me on behalf of the O&P Alliance at (202) 349-4261 or at

Sincerely, Peter W. Thomas Counsel for the O&P Alliance

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