As expressed in the January 2024 issue of the Disability and Health Journal, the 50th anniversary of the passage of the Rehabilitation Act of 1973 in 2023 marks a significant milestone in U.S. disability policy. In September 2023, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), issued a long-awaited proposed rule that updates nondiscrimination regulations enacted by the Rehabilitation Act of 1973. The rule strengthens prohibitions against discrimination on the basis of a disability in health care and human services programs. It makes significant updates to Section 504 of the Rehabilitation Act rule 50 years after the law was enacted to advance equity and strengthen protections for individuals with disabilities in this nation. Also, the year 2023 saw two additional potential shifts in U.S. disability policy.
The National Institutes of Health (NIH) sought comments to eliminate the ableist language of “reducing disability” from the NIH mission statement. The proposed revised statement, “To seek fundamental knowledge about the nature and behavior of living systems and to apply that knowledge to optimize health and prevent or reduce illness for all people,” aims to remove any potentially ableist notions that these individuals inherently are flawed and need to be fixed. Additionally, in September 2023, the National Institute on Minority Health and Health Disparities (NIMHD), designated persons with disabilities as a population with health disparities for research supported by NIH. This designation represents an important shift and would allow for NIH investment in research that unambiguously focuses on disability and health disparities and incentivizes efforts to recruit researchers with disabilities and disabled people as participants in clinical research.
Parity In Insurance Coverage Between Mental And Physical Health Care
Politico in January 2024 described efforts by former Congressman Patrick Kennedy (D-RI) who can see a path to his longtime goal of achieving parity in insurance coverage between mental and physical health care. An eight-term legislator who retired from the House at the end of 2010, he was the author of the 2008 Mental Health Parity and Addiction Equity Act that ordered insurers to cover mental health on the same terms as physical health. Unfortunately, what occurred after this law was enacted never quite evolved into what originally was envisioned. The former representative paid attention when insurers complained last year that the path to parity is blocked by workforce shortages. In response, he wants to convene labor unions, insurers, and the government to develop a way to boost the mental health workforce. He favors creating an AFL-CIO for addiction, adding that Congress can help with “an infrastructure bill” for mental health. He also sees a bigger role for community mental health centers, initially funded under the last piece of legislation (P.L. 88-164, Community Mental Health Act of 1963), his uncle, President John F. Kennedy, signed into law on October 31 before his assassination. He wants community behavioral health centers to integrate with physical health centers to better serve Americans with mental health issues.
Historic Selection Of ACA Marketplace Health Insurance Coverage
The Centers for Medicare & Medicaid Services on January 24, 2024 announced that 21.3 million individuals selected an Affordable Care Act (ACA) Health Insurance Marketplace plan during the 2024 Open Enrollment Period. Total plan selections include more than five million beneficiaries — about a fourth — who are new to the Marketplaces and 16 million others who renewed their coverage. The Biden Administration has continued its commitment to making health insurance available and affordable to everyone. The Inflation Reduction Act (IRA) and the American Rescue Plan continue to keep Marketplace coverage affordable. Thanks to the IRA, four in five HealthCare.gov customers were able to find health care coverage for $10 or less per month for plan year 2024 after subsidies. Compared to the Open Enrollment Period last year, nearly 4.2 million more individuals with household incomes less than 250% of the federal poverty level (about $75,000 per year for a family of four) enrolled in 2024 coverage, demonstrating that when coverage is affordable, beneficiaries enroll. Marketplace coverage also has been critical for many individuals transitioning from Medicaid or the Children’s Health Insurance Program (CHIP) as states conduct eligibility renewals, which restarted last year. Additionally, almost $100 million in Navigator Awards were issued, allowing organizations to hire staff trained to help consumers find affordable, comprehensive health coverage. Navigators, as they are known, have been key to helping consumers in every Marketplace state.