While we pursue independence and autonomy for audiologists across the United States, it is of dire importance that we continue to do the same for our patients. Since the passing of the Medicare Act in 1965, health-care legislation has evolved to accommodate new advances in technology for the betterment of our patients. That vital piece of legislation, however, still has done nothing for those requiring hearing amplification. Luckily for children and low-income families qualifying for Medicaid, hearing aids are covered in some part, in every state across America. At the time of this article, 34 of the 50 states have adopted Medicaid expansion, increasing the availability for enrollees to have not only health care but hearing amplification as well. For those with private insurance, however, that isn’t always the case.
Most Americans with health insurance qualify through their employer. The benefits received through those insurers can vary for each and every plan. Some companies might offer more services for slightly increased premiums, and others stick to standard plans that do not include the option for added coverage. While it may be great to find an insurance plan that includes coverage for hearing aids, the reality is that the majority of private insurance plans (i.e., Blue Cross/Shield, Aetna, UHC, etc.) do not provide this benefit.
There are more than 20 states that have an insurance mandate requiring coverage for hearing aids in children. A select few of those states require that private insurers cover hearing aids for both children and adults. Two states require coverage for both hearing aids and cochlear implants. While it seems great that many states mandate coverage so their citizens receive care, that means that more than half of the states in America have no coverage for these necessities.
If you are wondering what can be done and live in a state that doesn’t have this coverage, turn to what is happening in the state of Nebraska. In the past two years, the Nebraska Speech–Language and Hearing Association (NSLHA) has initiated what could be described as a legislative uprising to remove unnecessary and outdated red tape, as well as improve the access to audiological and speech services our patients require. This included regularly meeting and developing relationships with state legislators, actively testifying at committee hearings at the state capitol, and even enlisting members to research and write legislation to be sponsored by legislators.
Recently, the Nebraska Commission for the Deaf and Hard of Hearing (NCDHH) requested to meet with members of NSLHA to discuss a joint effort to address the problem of access to hearing aids for children. Several meetings took place over the course of six months, in which several ideas were introduced and discussed.
The first idea involved an amazing program called HearU that was started by a local audiologist and run out of the University of Nebraska audiology program. The program, with the help of grants and donations, provides hearing aids to children in need whose families do not have the financial ability to pay for them.
Several stakeholders from both NSLHA and NCDHH met with the lieutenant governor of Nebraska, who thought the idea would be a great appropriation to help many families across the state. He has since agreed to help support the appropriation in the coming legislative session. If approved, the funding would be allocated to the NCDHH, which would support the HearU program.
The second idea was a piece of legislation that would mandate private insurers to provide coverage for children who require hearing aids. The bill, which was researched and written by an NSLHA member, would provide a specified dollar amount that would be available per ear every three years. As previously mentioned, many states are moving toward these mandates. Insurance mandates, however, are very difficult to pass in a state legislature. The bill as written already has sponsors and will be introduced during Nebraska’s 2019 legislative session, which begins in January.
Every bill introduced in the Nebraska legislature receives a full committee hearing, which is not common in most states. Planned testimony during the committee hearings will include several family members whose children use hearing aids, and local professionals.
Following debate over the two options, stakeholders decided to move forward with both options. The first option of an appropriation seems likely to be approved. This will allow the funding of HearU to move forward uninterrupted. It is hoped this appropriation will be recurring for years to come.
Simultaneously, the insurance mandate bill will be advocated as well. As previously mentioned, this insurance mandate is difficult to pass and will likely meet many roadblocks along the way. It will require more resources, but the legislative members at NSLHA are dedicated to getting it passed. It should be noted that all members participating in this work are volunteers and do not receive additional compensation.
Advocating for your profession requires a tremendous amount of work behind the scenes. It is more than a hashtag on Twitter or sharing a post on Facebook. Advocating is about action. The more our professionals work to make change on a local and state level, the easier it will be to make change happen on a federal level.
We commonly see a strong presence of the Student Academy of Audiology on both the state and federal level. The dedication of the students coming into the field fighting for their futures and that of our profession is something in which we should take great pride. What we don’t see is that same collective, fierce presence among practicing professionals across the United States. If we want to see change—more of us need to roll up our sleeves and make it happen.
The change will never present itself on a silver platter, so we will have to create the opportunities for ourselves. It does not take a large group of people to make an idea seem feasible. It just takes that one person with an idea who realizes a way to make us better as a profession moving forward.