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Health Benefits and Disability

November 21, 1994

I completely agree with the headline on Paul J. Feldstein's Nov. 14 commentary, "Prop. 186's Defeat Need Not End Reform." Unfortunately, his recommendation to eliminate state mandates (except for requiring everyone to have "minimal catastrophic coverage") is likely to result in a system that discriminates against people with disabilities and chronic or unusual illnesses.

That's because whenever benefit packages are pared down to "bare bones," they tend to eliminate or severely limit the very things that people with disabilities need most--things like prescription drugs, rehabilitation services, durable medical equipment, home- and community-based long-term care services and mental-health benefits. In fact, Feldstein specifically mentions certain disability-related services (mental-health benefits and orthotic/prosthetic care) in the list of items that he considers "desirable" but unaffordable.

The result, at best, would "permit" people with disabilities who can afford coverage to pay into a system that would meet other people's health needs but not their own. As for those who can't afford it, they will be forced onto welfare just to qualify for critical services that might otherwise allow them to work and pay taxes.

Interestingly, Feldstein credits "low-cost managed-care insurers" for keeping the growth in California's per capita health spending below the growth rates for the United States and Canada. To those of us who have disabilities and/or work with the disability community, that's far from reassuring. We know that people with disabilities frequently have problems accessing even covered disability-related benefits in such managed-care plans. Erecting barriers to needed health services might show up on the balance sheet as a "saving" for the health-care system, but the effect is to deny many disabled people the right to an independent, productive life.

According to Ed Roberts, former director of the California Department of Rehabilitation and current president of the World Institute on Disability, 80% of us will experience disability at some time in our lives. California voters may have said no to Prop. 186, but they haven't said no to other reforms that will protect them when it's their turn to deal with disability. That's an important distinction that Feldstein, the California Legislature and Congress should remember as they seek new approaches for reforming our health-care system.

LAURA REMSON MITCHELL

Government Issues Coordinator

National Multiple Sclerosis Society

Canoga Park

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