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Is The Affordable Care Act a Good Thing or a Bad Thing for the Disability Community?
Stephen W. Dale, Esq., LL.M
It's a fair question, and one that may take time to answer. The priority should always focus on the need to create sustainable systems to achieve quality of life. SSI, Medicaid, and private health insurance are merely tools. The needs of each person with disabilities and their families are unique to their situation - and the special needs trust practitioner must structure a framework that not only deals with the system as it is today - but also well into the future.
Even if the ACA proves to be a wild success that opens new doors - we still face residential needs that are almost universally inadequate or absent along with the unacceptable incidence of abuse and the lack of monitoring and prevention. I believe that the ACA is, for the most part, good. We need to have both private and public systems that provide sustainable healthcare services throughout our community; basic opportunities for appropriate housing and supports, freedom from abuse and neglect, and access to community services. This is part of the promise of deinstitutionalization movement started over 60 years ago - yet to be fulfilled. A colleague of mine, David Lillesand, of Lillesand and Wolasky, P.L. contributed the following to a blog by Judy Owen sponsored on the Forbes website: The most obvious and most significant health industry reform important to our SNT clients is the elimination of pre-existing conditions as a bar to purchasing private health insurance. However, ACA also eliminates annual or lifetime caps, rescission of insurance policies, non-renewability, and higher premium costs for persons with pre-existing conditions. For individuals with significant medical problems, elimination of cost-containment ceilings is just as important as access to the door of private medical care. It is not unusual to see clients who have maxed out their lifetime cap and are now seeking public health insurance. To read the entire blog, click here Meanwhile, a story entitled Obamacare: People with Disabilities Face Complex Choices by Eric Whitney which ran recently on NPR stated: "(Lisa) Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want specific therapies covered are going to have to slog through some fine print to figure out if they'll actually benefit from a particular policy. (The new policies will start to go on sale this fall, and go into effect beginning Jan. 1, 2014.) "This is a big improvement, but we should emphasize that it's not totally fixed," Clemans-Cope says. "And people are really going to have to get help to decide which plans cover the benefits they need." Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits that insurers have to provide in each category is based on a model policy in each state, and some of those policies are a lot more generous than others. To read this article, click here So what does this mean? It means that it will take years and lots of trial and error to work this out. It also means that it will depend on where you get your insurance from and how they run their coverage, as well as what state you live in - and to me this is one of the most overlooked issues, IT IS STILL UP TO EACH STATE. That issue never seems to change. Attorneys that are members of The Special Needs Alliance are working hard to research and learn how the ACA will affect families within their state. My recommendation to you, therefore, is: 1) There will be a number of options available to you. Research and choose your insurance package carefully. 2) Your state will have a hotline available to ask questions. USE IT! Here is a link provided by HealthCare.gov: https://localhelp.healthcare.gov 3) If you have (or need) a Special Needs Trust or other legal document to protect and/or provide for a loved one with a disability, I strongly suggest that you seek advice from your legal estate planner. If you do not have one, utilize the link provided on the SNA block to the left of this article to find one in your state. 4) Become involved in protecting community level programs providing services and support to people with disabilities. Whether you utilize them now, you will surely want to have them available for the future! I have provided links to two very respected programs (The Arc and NAMI) on the left for your reference, but also remember local chapters are available for many disabilities. If you haven't called them, you should! | 
