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DREDF Continues to Closely Follow Health Care Developments

Tuesday, May 23, 2017

For many years, DREDF has been actively involved in a range of activities intended to advance, protect, and enforce the rights of people with disabilities to full and equal access to health care.

This work includes: (1) research and data collection on disability and health; (2) development of policy briefs on diverse health care topics; (3) trainings and presentations for people with disabilities, disability advocates, legal services advocates and attorneys, health care providers and health plan insurers; (4) development and dissemination of resource materials; (5) legislative education activities related to proposed federal and California health care-related laws; (6) participation in stakeholder gatherings and submission of public comments in health-care related administrative processes; and (7) participation as party and amicus counsel in health care-related litigation, and monitoring of judicial cases relevant to health care.

Longstanding general disability civil rights laws have applied to health care settings for decades, with detailed mandates for architectural, communication and programmatic access and nondiscrimination. Federal laws include Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. California laws include the Unruh Civil Rights Act (Cal. Civ. Code Section 51 et seq.); the California Disabled Persons Act (CDPA)(Cal. Civ. Code Section 54.1 et. seq.); and California Government Code Section 11135.

More recent developments include the Affordable Care Act (also known as "Obamacare"), Pub. L. 111-148, 124 Stat. 119 (2010). The ACA has had a widespread impact on the funding and delivery of health care throughout the United States, and it has extended health insurance coverage to an additional 20 million Americans. It is important to all Californians, but particularly to those in three categories almost entirely composed of those eligible for legal services. Those categories include: (1) Medicare-eligible individuals (predominately seniors and persons with disabilities); (2) Medi-Cal-eligible individuals (predominately those with low-incomes); and (3) those who have not historically had access to employer-provided health care, which predominately includes unemployed, part-time and low-wage workers.

Following its passage, as is often the case with major legislation, the ACA was the subject of constitutional challenges, and statutory challenges as to its scope and meaning. The ACA survived constitutional challenges, and judicial decisions left intact the key provisions and interpretations critical to its successful implementation. Those provisions include the "individual mandate" (requiring most people to obtain and maintain health insurance coverage), and the obligation for health insurance providers to offer ten enumerated "essential health benefits." The ACA also mandated the creation of "health insurance exchanges," which serve as online marketplaces for health insurance. "Covered California," the Golden State's exchange, was launched in 2013, and remains up and running at http://www.coveredca.com/.

As enacted, the ACA also included a statutory provision mandating nondiscrimination in health care programs and activities that receive federal financial assistance. This "Section 1557" provision encompasses a variety of diversity characteristics, including disability. Again as is common with major new legislation, Congress anticipated that the details needed to realize this nondiscrimination mandate would be addressed in administrative rulemaking. DREDF was actively involved in the rulemaking process leading up to the final Section 1557 regulations, which were issued by the U.S. Department of Health and Human Services in May 2016.

In 2017, as the U.S. has transitioned from one presidential administration to another, there have been renewed efforts to repeal the ACA, as well as to cut funding for Medicaid healthcare and home- and community-based services. In March 2017, the original version of the repeal-and-replace bill, known as the "American Health Care Act" (AHCA), was withdrawn before a planned vote in the U.S. House of Representatives. On May 4, 2017, a revised version of the AHCA was passed by the House. It will now proceed to the Senate, where it faces significant opposition.

Regardless of what happens this spring, it is clear that threats to the ACA, as well as threats to critical health care funding mechanisms, will remain ongoing throughout the new presidential administration. Recognizing the need to continue humanizing this subject, DREDF has recently released four new "Health Care Stories," part of a series begun in 2011 to provide detail on the real-world implications of these threats to people with disabilities.

DREDF will continue to be actively involved on health care issues. For more information, please visit our website at https://dredf.org/healthcare-access/.

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