Federal Legislative Issues
Senate Veterans Affairs Committee Holds Brain Injury Benchmarking Hearing
On May 5, 2010, The Senate Veterans Affairs Committee held a hearing examining the efforts of the Department of Veterans Affairs in responding to the rehabilitation needs of veterans with TBI since the passage of the TBI-related provisions as part of the National Defense Authorization Act of 2008
Mike Dabbs, President of BIAMI, testified about the need for an increased public/private partnership between the VA and private health care providers in order to insure that veterans can access the best care possible. For further reading, the full testimony is available on BIAMI's Web site. Nebraska's efforts were outlined in testimony submitted by NASHIA.
This hearing comes after the Veterans' Health Care Authorization Act that was cleared in April. Because of the specific language in the bill regarding veterans with brain injury and access to non-VA providers, in which BIAA and the Wounded Warrior Project advocated for tirelessly, BIAA is hopeful that the provisions in the bill as well as the outcomes of the May 5th hearing will serve to dramatically increase access to care for the veteran population across the country.
BIAA Endorses the Christopher Bryski Student Loan Protection Act
BIAA joined Congressman John Adler in support of a bill that would ensure a method be in place when applying for Federal or Private student loans to designate who will make decisions on your behalf regarding all medical, financial, and legal matters in the event you are catastrophically ill, catastrophically injured, temporarily disabled, permanently disabled or deceased.
On June 17, 2004, 23 year old Christopher Bryski fell forty five feet to the ground in a recreational accident. He sustained a severe Traumatic Brain Injury and was in a coma for approximately 4 weeks. After emerging from the coma Christopher remained in a persistent vegetative state for almost two years before passing away on July 16, 2006.
At the time of Christopher's accident, he was in his third year of academic study at Rutgers University and needed to supplement his federal student loans with a private alternative education loan through a private lender, in which his father was a co-signer and is still liable after his death for the amount of the loan.
The bill introduced by Congressman Adler would address this important issue for parents and caregivers in the following ways:
Any private educational lender (i.e Citibank, Wells Fargo, Chase, PNC, etc.) shall:
- Discuss with the student and the cosigner of the loan the benefits of creating a power of attorney, in the event of the death of incapacity of the student or cosigner
- Define clearly and concisely the obligations of the cosigner, including the effect of death or incapacity of the student or cosigner
- Discuss with the student and the cosigner the benefit of credit insurance in connection with the loan, however the private educational lender may not require credit insurance or deny a loan on the basis that the borrower or any cosigner has not obtained credit insurance
- Gives power to the Federal Reserve to define death or incapacity in conjunction with the Secretary of Education and institute standards regarding the borrower's or cosigner's obligation if the borrower or cosigner were to die or become incapacitated
Federal PLUS Loans and Federal Consolidation Loans:
- Discuss with the prospective borrower the uses and benefits of creating a durable power of attorney in the event of the death or incapacity of the borrower or the student on whose behalf the loan is borrowed by the parent borrower
Amends Entrance Counseling requirements for Federal Loans:
- Provide information during entrance counseling that describes the loan discharge rules in the case of death of disability, and the possibility that private loans may not be discharged upon death or disability
- Provide information with respect to creating a durable power of attorney and its benefits and uses
Veterans Health Care Omnibus Bill
On Thursday, April 22, 2010, the Senate cleared an omnibus veterans' health care measure that provides important assistance to both veterans and caregivers. S. 1963, as modified by the House, includes nearly $1.6 billion in authorizations for programs designed to aid caregivers of eligible veterans.
The measure, which now goes to the White House for President Obama's signature, is intended to strengthen the health care support system for veterans and to expand services in rural areas. The measure will also expand caregiver programs, making them eligible for training and education assistance.
The bill also authorizes VA hospitals to contract with non-VA providers, as stated in the bill:
"The Secretary may contract with appropriate entities to provide specialized residential care and rehabilitation services to a veteran of Operation Enduring Freedom or Operation Iraqi Freedom who the Secretary determines suffers from a traumatic brain injury…" Both BIAA and the Wounded Warrior Project have long advocated for approval of this measure and yesterday's final passage signified a great victory for service members who suffer from TBI and their families.
Health Care
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (H.R. 3590). One week later, he signed the Health Care and Education Reconciliation Act of 2010 (H.R. 4972). Together, these laws represent the most sweeping health care reforms in U.S. history. Some of the most important provisions for individuals with brain injury and their families include:
The opportunity to keep your current health insurance, assuming you make premium payments on individual or group plans and/or maintain eligibility for Medicare and Medicaid programs;
A mandate on individuals and employers to obtain or provide health insurance by 2014 or face penalties, except in the case of financial hardship and religious objections;
Creation of a high-risk pool to provide immediate assistance to those currently uninsured with pre-existing conditions before insurance market reforms are implemented;
Establishment of state-based Health Insurance Exchanges effective in 2014 with an essential benefits package that requires coverage for hospitalization, physician services, prescription drugs, rehabilitation and habilitation services and devices, vision and oral pediatric services, mental health services and chronic disease management services, among others;
Major insurance company reforms phased in between 2010 and 2014 for individual and small group plans such as the elimination of discrimination based on health status, a prohibition on pre-existing condition exclusions (including implementation of an immediate ban on exclusions for children), guaranteed issue and renewal requirements, and the elimination of annual and lifetime caps;
Inclusion of the Community Living Assistance Services and Supports (CLASS) Act , a new actuarially sound, premium-based, voluntary, national long term services insurance program to help adults with severe functional impairments to remain independent, employed, and a part of their communities, without having to impoverish themselves to become eligible for Medicaid;
Inclusion of a Community First Choice Option to Provide Medicaid Coverage of Community-Based Attendant Services and Supports, allowing states to offer such services to people otherwise eligible for Medicaid institutional services;
Significant investments in Medicaid to dramatically expand eligibility;
Substantial federal subsidies and out-of-pocket limits to make coverage as affordable as possible;
New mechanisms and payment methods to better coordinate chronic care for people with disabilities;
An extension of the exceptions process to the Medicare therapy caps on physical, occupational, and speech and language therapies;
Development of standards for accessible diagnostic and other medical equipment;
Inclusion of individuals with disabilities in research and data collection;
Major federal investments in prevention and education/training for allied health professionals.
IMPORTANT NOTE: Rehabilitation was not included in the original version of the Senate bill that became law. It was only through the Brain Injury Association of America's relentless advocacy that this vital component of brain injury recovery was listed as a covered service that individual and small group health insurance plans will be required to provide as of 2014. The importance of this victory for people with brain injury cannot be overstated, but there is still critical work ahead on regulatory language and enforcement. BIAA is deeply grateful to its nationwide network of advocates and the generous donors who supported our health care reform campaign.
