We haven’t received any pushback so far on our new article about the factors that drive sky-high prosthetic costs (“Playing the Market”). That’s a mild surprise, as healthcare costs are a complicated subject and often a sensitive one. Then again, it’s not any secret that prosthetic devices are distressingly expensive, and it’s not controversial to argue that lower prices are both desirable and possible.
Quite the contrary: A consensus is forming that affordability is good not only for amputees but also for prosthetists, manufacturers, insurers, and the healthcare system overall. That’s why Medicare’s proposed coverage expansion for microprocessor knees is likely to get approved: Over time, more robust coverage will cut healthcare and social spending by billions of dollars. The evidence shows that by investing in amputees’ long-range health, the government sharply reduces the exorbitant costs associated with chronic disease, falls, depression, pain management, underemployment, and so on.
The same principle explains the outpouring of bipartisan support for the So Everybody Can Move (SEBCM) bills that already have passed in five states and are currently pending, or planned, in about a dozen more. While details vary from state to state, SEBCM bills require private insurers to cover more amputees and/or more types of prosthetic devices, including activity-specific devices such as running blades. Even states that were skeptical of the cost-saving promises of the Affordable Care Act have embraced the fiscal rationale behind SEBCM. The numbers are just too persuasive.
And fresh numbers are about to be published. Shaneis Malouff and Jeffrey Cain, whose 2023 paper helped get SEBCM bills across the finish line in Colorado, New Mexico, and Illinois, are back with a new peer-reviewed study that’s supported by more expansive, higher-quality data. Due to be published next month in Medical Research Archives, this analysis finds that states with pending or planned SEBCM bills could reduce their healthcare and social services expenditures by anywhere from $50 million to ~$400 million per year by requiring insurers to offer adequate coverage for prosthetic and orthotic care.
Advocates throughout SEBCM’s network have received a preprint of this study, and a copy has been shared with Amplitude. The upshot is that So Everybody Can Move might as well be rebranded as “So Everybody Can Save“: Empowering amputees to maintain their own fitness is a lot cheaper than skimping on prosthetics but paying to treat heart disease, vascular disease, obesity, and other consequences of immobility.
Here are a handful of eye-popping top-line numbers from the paper.
$2,500 per patient, per year
That’s the average reduction in healthcare expenditures for individuals who meet the Centers for Disease Control’s exercise guidelines, compared to people who don’t meet the guidelines. Meeting the CDC’s standards (e.g., walking 30 minutes a day, five days a week; weightlifting two or more days per week) is pretty much impossible without well-fitting, high-performing prosthetic gear. Ergo, flimsy insurance means less active amputees, which in turn leads to health complications that are vastly more expensive and problematic than prosthetic care. The costs of those complications fall not only on amputees but also on insurers, taxpayers, and health facilities, so everyone pays when people with limb loss aren’t given the opportunity to stay active. BTW, the data underpinning this conclusion come from a 2021 American Heart Association study.
$0.01 to $0.38 per month
This is the average estimated insurance-premium increase, per member, that would result from passage of the 11 SEBCM bills examined in Malouff and Cain’s study. You read that right: People who are insured through their employer or another non-government provider would only pay, at worst, 38 cents a month, or a little over $4 per year, to ensure decent O&P coverage for every amputee. Costs of Medicare, Medicaid, the VA, and other government insurers wouldn’t be affected at all.
The estimated premium increase actually varies from state to state, with New Hampshire at the low end ($0.01 to $0.05 per member, per month) and Pennsylvania at the high end ($0.01 to $0.89 per member, per month). Those are conservative estimates, Malouff and Cain emphasize. In fact, when Minnesota and New Jersey ran independent fiscal analyses, their estimated premium increases were even lower than the figures presented here. So there’s a reasonable chance that 38 cents a month overstates the financial burden of the SEBCM bills.
$0.00001
Here’s the expected impact of each individual prosthetic device on monthly premiums: one-thousandth of a penny. Got that? For every 1 cent increase in monthly premiums, insurers could put 1,000 amputees into everyday prosthetic devices and/or activity-specific devices (e.g., running blades). It’s awfully tempting to say this essentially translates to $0, but those microfractional pennies do add up: Multiply $0.00001 times 12 months a year times millions of premium-paying insurance customers, and you end up with annual state costs that range from $452,000 for New Hampshire (the least populous state in the study) to $62 million for Pennsylvania (the most populous state). Not chump change. But weigh those numbers against . . . .
$51 million to $417 million per year
If the 11 states in this study were to pass SEBCM bills, the potential net savings range from $51 million to $417 million per year, or billions of dollars over time. That figure is derived by subtracting the increased costs of broader coverage—all those mountains of $0.00001 premium payments—from the healthcare and social spending reductions that result from a healthier population. The major caveat is that, in order to realize benefits that large, every single amputee who received a prosthesis would need to take advantage of it—i.e., they’d need to become active enough to meet the CDC exercise guidelines cited above. While it’s overoptimistic to assume a perfect record in that regard, a less-than-perfect record would still yield annual savings in the tens to hundreds of millions of dollars. Few legislators in budget-strapped state—and they’re all budget-strapped—are going to sniff at that kind of dough.
