75 million people in the world cannot afford a wheelchair. To put that into perspective, that is about three times the population of Australia and 57% of all individuals that require a wheelchair.
And that’s just wheelchairs. It is estimated that only 1 in 10 individuals have access to an assistive device (World Health Organization). But why is this the case in the U.S. when MediCare covers 80% of costs? To understand this long-standing, critical issue we need to delve deeper into insurance policies and their practical applications.
First and foremost, 9.6% of U.S. residents are uninsured and studies estimate that up to 60% of the homeless population has no insurance. (Jain). When it comes to DME on the account of an injury or sickness, this population has no choice but to pay entirely out of pocket. For the homeless population, who are the most vulnerable to injuries due to dangerous living conditions, even DME that falls on the lower range in terms of cost such as crutches might be inaccessible. Their limited mobility hinders them from traveling and obtaining elemental necessities such as food and medicine. Independence and a reliable source of income becomes a far-fetched idea with such limited mobility. For others, equipment such as electric wheelchairs and scooters can cost thousands of dollars which even a middle class family cannot afford in the absence of insurance. Many have to resort to using basic, often unsuitable or broken devices that do not completely meet their needs. This lack of proper DME can prevent an individual from going to work, earning for the basic needs of their family, and lowers the overall quality of their life. Now what about those that do have insurance?
Medicare Plan B states that it covers up to 80% of DME costs when both the doctor and the supplier are enrolled in Medicare and when it is medically necessary for the individual. (Medicare). On the surface this sounds like a pretty good policy, but in practice there are many hidden facets that prevent an individual from obtaining medical equipment. For those that qualify for Medicare, getting a prescription for a particular item may take months as it requires a face-to-face appointment with a doctor and switching to Medicaid on the basis of a disability itself takes 29 months, a window in which a patient has no coverage of any required DME. On top of that, there is a heap of paperwork (which increases when an individual requests a power wheelchair vs. a manual one) that has to be completed which is simply too difficult for a disabled individual to navigate. When it comes to the specifications of what equipment will be provided to the individual, the price of the equipment is often capped such that a patient has to settle with the device that does not provide the safety or functionality a user desires (Sehgal 12). On top of that there is a specified window that strictly delineates when the DME can be replaced in case of breakage. Take into account this statement from Burt Pusch, a retired professor disability advocate (Seervai, Shah).
“My wheelchair equals ‘my legs.’ But under [Centers for Medicare and Medicaid Services] rules, I can only get a new chair every five years…A lot of the people I know have wheelchairs that are falling apart. Their chairs are literally being held together with duct tape and wire. These individuals have been denied approval for a new chair because of some arbitrary five-year magic window”.
An initial glance at Medical’s policy for DME makes this account sound preposterous, but this is the reality for so many disabled individuals and seniors. Of course, there are many who do not medically require DME but need it for their own comfort and well-being which might be occasional leg pain or a light injury. They are left with no choice to purchase DME, which implies that only those that have appropriate financial resources can enjoy the stability and comfort that DME offers while others are forced to live with limited mobility and endure the pain they may experience on a daily basis.
When it comes to private insurance, the situation only gets more dire. In 2000, private insurance companies paid $6 billion for individuals with disabilities and disabled individuals paid $34 billion out of pocket. (U.S. Department of Health and Human Services). This has cultivated a more massive gap in the access of DME between wealthier and low-income households.
Insurance policies and the discriminatory nature in acces to DME that they propagate has adverse effects on none other than disabled individuals themselves. The array of effects include deteriorating mental health as many are unable to leave their homes and integrate into their communities. Disabled individuals are three times more likely to experience suicide ideation than the general population. (CDC). They are more likely to be obese, smoke cigarettes, and be physically inactive. (Sehngal 4). In conclusion, little to no access to DME leads to a worsening quality of life for disabled individuals.
The barriers to equitable access to DME are far from over, but we here at Get A Cane aim to turn the situation around by recycling medical equipment. All devices are given out to those in need, many of which are victims of the insurance policies discussed above. We need your help to move a step closer in solving this major problem, so please consider donating.
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