As someone who has a hearing loss, I am contacting you to discuss several issues related to the current attempt to fix health care in America. I understand that lawmakers like to read short letters from their constituents on matters that are important to them and I will try to be brief regarding in my request to consider the needs of people who are Deaf or hard of hearing when reforming health care.
Section 1557 of the ACA
Although I am not a fan of the Affordable Care Act (ACA), there is one section of the law that is extremely important to those of us who have a hearing loss. The ACA has a section called Section 1557, which is also known as the “nondiscriminatory rule.” This section applies to any health program or activity, any part of which receives HHS funding, such as hospitals that accept Medicare or doctors who receive Medicaid payments; the Health Insurance Marketplaces and issuers that participate in those Marketplaces; and any health program that HHS itself administers (Medicare Part B is excluded).
In Section 1557 it states that covered entities must give “primary consideration” to an individual’s choice of aid or service. This standard is the same as Title II of the ADA “Primary Consideration Rule.” What that means is when a person who is Deaf attempts to access government programs, benefits and services the government entity must give “primary consideration” to the auxiliary aid or service requested by the person who is Deaf. What that means is the government agency must give the person who is Deaf the specific aid they requested, like a live interpreter, or the government entity must prove it was not needed.
This section is important because Deaf people often have to fight with doctors and hospitals to obtain a live ASL interpreter so that they can get the effective communication they need to understand the medical advice from the medical professional that they are meeting with.
If Congress ever gets around to successfully repealing ObamaCare, then Section 1557 goes away which means people who have a hearing loss lose out on an important protection that the law provides to us.
I support the idea of replacing ObamaCare with legislation that supports the free market in making healthcare affordable to the public. However, please ensure that the language and protections of Section 1557 remains in place in the new health care law.
OTC Hearing Aid Act
The OTC Hearing Aid Act (OTCHAA) is a bipartisan effort to make it easier for people with hearing loss to purchase hearing aids. The OTCHAA is being proposed by by Sens. Elizabeth Warren (D-Mass.) and Charles Grassley (R-Iowa) in the Senate (as S.670), and Reps. Joe Kennedy III (D-Mass) and Marsha Blackburn (R-Tenn.) in the House of Representatives (as HR 1652).
The OTCHAA is a free market solution to the problem of making hearing affordable to all individuals with a hearing loss. At $2,500 apiece, hearing aids are beyond the reach of many Americans --- especially seniors who are most likely to need them (among people 70 and older, two-thirds have a hearing loss affecting their daily conversation). The cost of hearing aids is not covered by Medicare, or by most insurance companies.
Currently, Six firms (only one of which is based in the U.S.) dominate the hearing aid market, producing 98 percent of all devices sold. New market entrants are rare for a number of reasons, including most importantly, regulations that restrict hearing aids to only being sold by hearing professionals. Distribution is effectively blocked to newcomers due to close relationships between existing manufacturers and those professionals (audiologists, hearing aid dispensers, and physicians). In this low-competition market where professionals serve as the gatekeepers to hearing aids, innovation is slow to reach patients and hearing aids remain expensive.
By opening the market to OTC aids, manufacturers of consumer electronics -- from giants such as Apple and Samsung to small startups --- could enter the hearing aid space and sell directly to consumers. Hearing aids could be sold in a number of venues, including pharmacies, grocery stores, and other retailers. We now have over the counter reading glasses and over the counter pain killers and over the counter flu medicines. These options don’t prevent people from getting prescriptions for the heavier drug dosage or more personalized contacts and eyeglasses. Thanks to the internet, consumers are much smarter and cost-conscious about what their range of choices are than 20 years ago.
Passing this law would help make the cost of obtaining hearing devices easier for those who have mild to moderate hearing loss. It would also help those who have severe to profound hearing loss obtain hearing aids because it would drive down prices for all hearing devices by increasing choice and competition.
The other upside of this bill is that it would direct the FDA to come up with safety and effectiveness standards for these new hearing aids because there are dozens of the devices on the market, but their quality varies wildly and there's no easy way for potential purchasers to figure out which work best. This law would fix that problem.
The only drawback to this bill is that it does not address the failure of the hearing health professional to educate regarding how hearing aid consumers can get the most out of their hearing aids, including how hearing aids can work with ADA compliant assistive listening devices denies the consumer access to an equal and effective opportunity to meaningfully communicate in public settings. This includes access to venues such as, but not limited to: court rooms, transportation hubs, law enforcement buildings, and educational settings. Utah House Bill 112, known as the “Hearing Instrument Specialist Amendments” could serve as a model for language that could be added to the OTCHAA that help the consumer receive crucial information about hearing aids that they have just purchased. Additionally, it would be great to require the hearing aid provider or seller to educate the consumer about the itemization of professional services and price transparency on the products or services that they sell.
Hearing Aid Insurance
The last issue that I would like to address that most insurance companies do not cover the cost of obtaining hearing aids. For example, Medicare does not cover the cost of hearing aids, but does cover cochlear implants and related services. Medicaid covers the cost of hearing health care products and services in some states for qualifying individuals, but in other states little or nothing is covered. Federal employees are able to choose a health care plan that includes hearing heath care. But many private health insurance plans do not include coverage for hearing health care. As a result, Congress could help make hearing aids affordable and accessible if it required private insurance companies as well as Medicaid and Medicare to cover the cost of hearing aids for both children and adults.
The Hearing Aid Assistance Tax Credit Act (Senate bill S.48), reintroduced in the Senate on January 5 by Sen. Dean Heller (R-Nev.), would provide a non-refundable $500 tax credit for the purchase of a single hearing aid, or $1,000 for two, once every five years for parents purchasing a hearing aid for a dependent child. This credit could also be used by persons over 55 years of age for the purchase of a hearing aid. In the past, a version of the bill introduced in the U.S. House of Representatives included a $200,000 per year income eligibility cap. A bill has not yet been introduced in the House. The Hearing Aid Assistance Tax Credit Act is a step in the right direction but it doesn’t cover the cost of hearing aids for those who are between the ages of 18 to 55.
Conclusion
It is my hope that the issues that I have raised in this letter can be addressed in the Better Care Reconciliation Act (BCRA) that Congress is currently considering. Please do not forget the needs of those who are Deaf and hard of hearing when it comes to improving health care in America.
Sincerely,
Jared Allebest, Esq.
