“The ACA is here to stay” — and so are profound health care inequities, unless corrected.
Public support for the Affordable Care Act is weakest among the elderly, and not without good reason: Those 65 and older are already covered by Medicare, and many are afraid the ACA might diminish that safety net. The most recent Kaiser Family Foundation tracking poll showed only 36 percent of this demographic felt positively about the ACA.
There is a way to change this paradigm.
Hearing loss is a disability that most commonly afflicts those who are elderly.
According to federal government data, while 14 percent of those aged 45-54 have hearing loss, the loss is considered disabling for just 2 percent of that age demographic. The percentage of those for whom hearing loss is disabling grows to 8.5 percent for those aged 55-64. After that the progression is quick. A quarter of those aged 65-74 have disabling hearing loss, and over half of those over 75.
To make this less abstract, based upon 2010 census data, 386,111 Washingtonians 45 and older would have had disabling hearing loss — with more than three-quarters concentrated in the Medicare age demographic.
A large number of those who could benefit from hearing aids have never used them: Only 16 percent of adults up to the age of 69, and just 30 percent of those over 70. The financial cost is simply out of reach for too many. Insurers refuse to cover hearing aids, as does Medicare. And yet the cognitive costs of a hearing disability are plain to see for all of us who have had a loved one whose inability to hear seems to accelerate other effects of aging. For my late grandmother it just seemed to be another way in which she became unplugged from the world around her. It became very hard to tell what she couldn’t understand and what she simply couldn’t hear.
Surely the ability to hear, if medical assistance would allow you to, is essential to whole body health. And yet the ACA does not include hearing among the 10 “essential health benefits” that comprise acceptable health insurance. In desperation, Americans resort to quack devices — many advertised in magazines or senior publications — that are just sound amplifiers. They tend to be little more paired to their wearer than the ear trumpets featured, often to comical effect, in movies about the 1800s. The purchase of such devices, whether by mail order or through a storefront, occurs without an audiologist’s clinical involvement. Because even hearing exams are not covered by most insurance, and not at all by Medicare, it is as if someone with a vision problem bypassed an eye exam and simply guessed their optical prescription. How well would that work?
In March, Congresswoman Debbie Dingell, D-Michigan, introduced the Medicare Hearing Aid Coverage Act of 2015, to repeal the exclusion of, and allow coverage for, hearing aids and examinations for them. The bill faces an uphill climb. Coverage of hearing aids would, for example, reduce the vast profits of Medicare Advantage insurers. Yet, such a benefit must begin somewhere, and if it not be covered through Medicare the chances are nil of politicians ever compelling it through the private insurance market.
In our state, such a change would benefit over 300,000 Washingtonians. It seems as much a matter of civil rights as health care.
Olympia attorney Brendan Williams is a former state representative and health care advocate.