Reducing Disparities Through Health Care Reform: Disability and Accessible Medical Equipment
28 Pages Posted: 3 Jul 2011 Last revised: 8 Jul 2011
Date Written: June 30, 2011
People with disabilities face multiple barriers to adequate health care and report poorer health status than people without disabilities. Although health care institutions, offices, and programs are required to be accessible, people with disabilities are still receiving unequal and in many cases inadequate care. The 2009 report by the National Council on Disability, The Current State of Health Care for People with Disabilities, reaffirmed some of these findings, concluding that people with disabilities experience significant health disparities and barriers to health care; encounter a lack of coverage for necessary services, medications, equipment, and technologies; and are not included in the federally funded health disparities research. The report also noted the absence of training in disability competence issues for health care practitioners.
This Article highlights an often overlooked barrier, basic medical equipment that is not accessible to people with disabilities. Twenty years after passage of the Americans with Disabilities Act of 1990 (ADA), many people with mobility impairments cannot get on to examination tables and chairs, be weighed, or use X-ray and other imaging equipment. I introduced this issue into the legal literature in a prior writing focused on the delivery of traditional women’s health care services. However, it is equally relevant to the delivery of basic preventive health care services to millions of men and women with mobility impairments.
Despite the seriousness of the problem, a review of all public and private enforcement activity brought to date reveals relatively few actions challenging inaccessible medical equipment under the ADA. Several recent settlements are promising, but have not yet generated meaningful and widespread changes in access to and provision of accessible equipment. As I have written previously, inaccessible medical equipment seems like a relatively specific and easily solved issue, but its persistence suggests a deeper, more complex problem for people with disabilities in the health care system.
In my prior writing, I analyzed the possibilities and limits of an ADA-focused litigation approach to the problem of inaccessible medical equipment. In this Article, I argue that the Patient Protection and Affordable Care Act, as amended (PPACA) offers a new approach to these pervasive barriers. The provisions of the PPACA focus on expanding coverage, controlling costs, and improving the quality of the health care delivery system. The PPACA also includes several, lesser-known provisions aimed at improving access to health care for people with disabilities. In particular, the PPACA provides for a standard-setting process for accessible medical equipment, opportunities for disability education and training for medical professionals, and improved data collection on the health and health care of people with disabilities. This Article brings attention to these lesser-known provisions and offers guidance on how they can be implemented together to most effectively address the problem of accessible medical equipment, as well as some of its underlying causes.
Part II of this Article reviews the health status of people with disabilities in general and examines the necessity of medical equipment such as examination tables, chairs, scales, and X-ray and other imaging equipment to the provision of basic preventive services to men and women with disabilities. Part III summarizes and evaluates the success of the ADA in ameliorating the unequal and inadequate care received by people with disabilities, and considers other proposed doctrinal reforms aimed at setting more specific standards for equipment. Unfortunately, it concludes that doctrinal reforms have not been as successful as hoped. Part IV introduces a new approach: structural and systemic reform through the PPACA, which includes a standard-setting process for accessible medical equipment, improved data collection based on disability, and opportunities for professional education about caring for patients with disabilities. The reframing of barriers and disparities faced by people with disabilities as an issue of health care access and quality under the PPACA - in addition to an issue of civil rights under the ADA - appears promising. Part V goes on to highlight a challenge in the development and implementation of equipment standards under the PPACA that has yet to be addressed. Specifically, in terms of accessible medical equipment in institutions - how much is enough? This part provides guidance on these issues, including suggestions on developing the PPACA’s data collection and provider education and training provisions to inform and reinforce the standard-setting process.
Keywords: Disability, Americans with Disabilities Act, ADA, Rehabilitation Act, Health care, Health care reform, Patient Protection and Affordable Care Act, PPACA, ACA, Health care policy, Access to health care, Health disparities, Medical Equipment, Preventative health care
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