Between 2000 and 2011, nearly half the states passed laws requiring insurance companies to provide reasonable coverage for prosthetic devices. But in the last decade, only one state (Connecticut) has signed such a bill into law. The root cause of the impasse mirrors the problem that has stalled so much legislation all over the country: political polarization. These days, too many elected leaders are rewarded for punishing the enemy party instead of solving problems their constituents.
That’s perhaps the most noteworthy thing about Virginia HB 925, a new law that strengthens the coverage mandates governing prosthetic technology. Authored by Delegate Danica Roem, who characterizes herself as a pragmatic consensus builder, it sailed through both houses of the state legislature without a single “nay,” passing 96-0 in the Republican-controlled House of Delegates and 40-0 in the Democrat-controlled State Senate. Among other things, the law specifically defines myoelectric, biomechanical, and microprocessor-controlled devices as “medically necessary” technology, eliminating one of the insurance industry’s favorite escape hatches.
“This was an example of forward-thinking government, and that’s something that doesn’t happen too often,” says Zachary Hearn, director of government relations for the Amputee Coalition. “Knowing that the amputee population is going to double in the next 20 or 30 years, and knowing that Virginia has a larger-than-average African American population, where the rate of amputation is higher than average, this was proactive government. It was a bill that we needed to have.”
In explaining how the bill earned unanimous support in these fractious times, Hearn says the bill’s proponents emphasized how HB 925 could be framed as a “win” by politicians on both sides of the blue-red divide. Democrats can claim it as an extension of the patient-centered reforms enshrined in the Affordable Care Act, while Republicans can emphasize the bill’s impacts on taxation and business productivity. “If you have an ill-fitting prosthetic device, that’s certainly going to impact your ability to work,” says Hearn, who testified in support of the bill before a legislative committee. “The state recognized that [fair insurance coverage] improves its citizenry in the sense of maximizing production, which then means there’s less reliance on government services and less reliance on taxes.”
“I don’t even like the term ‘insurance fairness,'” Hearn adds, “because one side of the aisle will criticize it as socialized medicine.” He prefers more neutral labels such as “patient-centered insurance,” which allows supporters from either party to position themselves as standing up for working families.
HB925 is not a perfect bill, Hearn concedes. To get it through the divided legislature, the sponsors had to include a carve-out for small-business employers, which exempts some insurance plans from the tougher regulations and therefore leaves some amputees unprotected by the bill’s provisions. But given the dearth of progress in insurance protections for amputees since 2012, an imperfect bill is still a significant victory for the limb-loss community.
Hearn hopes Virginia HB 925 will provide a template for similar bills in other states, and it might eventually serve as a model for federal legislation. “This shows that there’s an appetite to have insurance fairness nationwide,” he says. “We can take these individual wins and start looking more at the national scene. Hopefully, through the AAA Study Act, we’ll be able to identify creative ways for the federal government to step in.”