By Caitlyn Tucker & Haley Stang
Summary of the issue:
The Affordable Care Act (ACA) requires non-grand-fathered health plans from insurance companies offered in individual and small group markets to offer benefits for 10 essential health benefits (EHB). Habilitation and rehabilitation services and devices are one of the essential health benefits included in the ACA. Speech and language services are considered to be a habilitative and rehabilitative service. Without EHB, speech-language pathologists would be unable to assist many clients with speech, language, swallowing, or cognitive difficulties.
Why is this important?
It is important for these services to be covered by insurance because treatment may prevent further negative consequences for people with communication disorders. Speech and language services aid in the opportunity for children and adults to have the ability to communicate across various settings. Progress in communication not only aids in education and vocational opportunities, but it increases quality of life among individuals who are diagnosed with communication disorders. Children who are receiving speech and language services may benefit from being able to have a better understanding of the curriculum. Speech-language pathologists provide treatment for children with literacy disorders so they can function in a classroom and prepare for their future. Elementary and high school education is crucial to higher education and eventually finding a job. Without speech and language services being funded by insurance companies, we may see a decrease in young adults attending college and becoming successful members of society. Speech and language services are essential for all age populations of the United States. If these services weren’t compensated by insurance companies, the majority of individuals who have suffered from a stroke or disease of the CNS would be at risk for negative impacts in their quality of life based on communication disorders that may follow their medical conditions. For example, a client that has vocal nodules may be able to rehabilitate their voice with speech therapy. However, the client may have to undergo surgery if they are unable to get speech and language services.
As of now, habilitation mandates are projected to cost less than 1% of the total premium costs. In addition to the benefits listed above, more money will be saved in the future by retaining EHB because more people will receive the services they need by speech-language pathologists. However, the United States will have a larger amount of debt if insurance companies do not provide coverage for habilitative and rehabilitative services because more people may attend the hospitals or doctor’s offices rather than receiving these services. As a result, medical bills from hospital and doctor’s visits will increase which will contribute to more debt.