Obamacare: People With Disabilities Face Complex Choices : Shots - Health News The Affordable Care Act sets up categories of essential health benefits that insurance plans must cover. Some categories, such as maternity care and drug abuse treatment, are straightforward. But "habilitative services" — including treatments like physical and speech therapy — are much more subjective.

Obamacare: People With Disabilities Face Complex Choices

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The Affordable Care Act will require most Americans to have health insurance by the beginning of next year. The law also sets standards for what that health insurance must cover. That's potentially a big deal for people with disabilities.

The law could help thousands get therapies they can't get now to help with daily living. Still, the insurance companies have a lot of discretion as to what to cover, as Colorado Public Radio's Eric Whitney reports.

ERIC WHITNEY, BYLINE: For 20-year-old film student Bryce Vernon, time with speech language pathologist Jill Tullman is golden.

JILL TULLMAN: Now, Bryce, I want to show you this super cool, random button that I think you're going to love.

WHITNEY: Vernon has cerebral palsy. He speaks but only with the aid of a special computer that tracks his eye movements, allowing him to select letters and icons on a screen mounted to his wheelchair.

BRYCE VERNON: My name is Bryce Vernon. I live in Los Angeles.

WHITNEY: It's amazing technology. and Vernon gets a lot more out of it with Tullman's help. Today, at a special camp for kids who use this technology, she's helping him pre-load several different ways of saying goodbye.

VERNON: Later, dude, later. Bye. I'm out of here.

TULLMAN: Isn't that fun?

VERNON: See you later.

WHITNEY: Lots of people like Vernon could benefit from one-on-one time with a therapist to improve their daily living skills. But it's expensive and not all insurance plans cover it. The Affordable Care Act is changing that, says health economist Lisa Clemans-Cope, with the Urban Institute.

LISA CLEMANS-COPE: You're much more likely to find these benefits in a plan after 2014 in the individual market, than you would be today - far more likely.

WHITNEY: Far more likely because the health law now requires insurance companies to cover 10 categories of services they didn't have to before. Some are straightforward like maternity care, drug abuse treatment and preventive care. But other categories are broader, like the one that includes some services Vernon needs. And insurance companies can pick and choose which specific therapies they'll cover in each category.

For instance, physical therapy benefits to recover from broken bones can be much more generous than therapies for long-term help for chronic conditions, like speech therapy for kids with cerebral palsy. Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive conditions from signing up with them. And she says people who want specific therapies covered are going have to slog through some fine print, to see if they'll actually benefit from the new policies for sale in 2014.

CLEMANS-COPE: This is a big improvement, but we should emphasize that it's not totally fixed. And people are really going to have to get help, to help them decide which plans cover the benefits they need.

WHITNEY: Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits insurers have to provide in each category is based on a model policy in each state, and some are a lot more generous than others.

Activists for the disabled, like Jill Tappert in Colorado, say a lot of details still need to be sorted out, before they'll be able to say whether the health care law has changed things much.

JILL TAPPERT: I certainly hope that the way the Affordable Care Act is implemented is a game changer for individual in the disabilities community - it can be. The opportunity is there for policymakers to vastly improve lives.

WHITNEY: Bryce Vernon says his life is a lot better since getting the kind of help that many others may be able to get from the health law in 2014. He works hard to get the most out of the technology and therapy that let him speak.

VERNON: Never, ever give up.

WHITNEY: The new rules for what health insurance companies have to cover can be changed. Federal regulators plan to review them as the health law rolls out, and could make changes in 2016.

For NPR News, I'm Eric Whitney in Denver.

MONTAGNE: That story is part of collaboration, among NPR, Colorado Public Radio and Kaiser Health News.


MONTAGNE: This is NPR News.


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