State News

‘Limbs are not a luxury’: Impending insurance fairness legislation

Local amputee activists advocate for the eradication of insurance inequities within the limb difference community, amidst a current momentum for the implementation of the Amputee Coalition’s Insurance Fairness bill. 

Local amputee activists advocate for the eradication of insurance inequities within the limb difference community, amidst a current momentum for the implementation of the Amputee Coalition’s Insurance Fairness bill. 

Image By: Lyra Evans

With a present propulsion to pass the Amputee Coalition’s Insurance Fairness bill, Wisconsin limb difference activists continue to promote insurance equality for all within their community.

There are currently two million people living in the United States with limb loss — Shawn Faessler is one of them. 

The UW-Madison alum was fortunate enough to have insurance that would cover a prosthetic, restoring his mobility and independence. However, the majority of amputees cannot say the same due to the inability to afford high insurance costs and the onerous obtainment process.

In 2002, his left leg was amputated after he survived trauma. A few months later, he saw what he thought his life could have become — an experience that would send him into a three-year depression and cause him to question his own abilities for over a decade to come. 

“I saw three people out in public missing limbs. They were all panhandling,” Faessler reflected. “So I saw that and I had this mindset of, ‘If you’re missing a leg, you’re going to be panhandling. This is the life you have in front of you.’”

Such a perspective is not abnormal or irrational for the amputee and limb difference community to possess. Roderick Sewell Jackson, the first above-the-knee bilateral amputee to finish an Ironman and a hopeful 2020 paralympic, has been outspoken with his homelessness experiences. 

Due to the financial burden of being an amputee without adequate insurance, Jackson and his mother were forced into homelessness for five years. 

“She had to make the decision to get my legs amputated and she didn’t really have the funds necessary to get me prosthetics, so she filed for unemployment,” Jackson told Swimming World Magazine. “Even though that got me the prosthetics I needed — the ability to walk — it put us in a financial bind.”

However, Faessler was fortunate enough to never face the threat of homelessness after his amputation. He went on to receive a job promotion, raise three children and enjoy an active lifestyle. 

He expressed those accomplishments would not have been possible without the high-caliber  insurance coverage he had at the time of his amputation.

“When I had my amputation, I had zero restrictions that I was aware of. I had zero cost. Once I had taken the ambulance and was at the hospital, everything was covered. So, I had incredible insurance at the time,” Faessler said. “This doesn’t happen in this day and age. And look at where I am now because of that. So for me personally, it’s given me the opportunity to live a happy and full life.”

He is lead advocate and certified peer visitor for the Amputee Coalition since July 2017, giving him the opportunity to volunteer and support others with amputations and limb differences. 

Since his time of involvement, Faessler worked alongside other activists to end disparities among amputees. Recently, his efforts have been dedicated to advocating for legislation changes, including the implementation of the Amputee Coalition’s Insurance Fairness bill within Wisconsin. 

The Amputee Coalition is a nonprofit organization whose mission is to “reach out to and empower people affected by limb loss to achieve their full potential,” through education, support, advocacy and to promote limb loss prevention.

The non-profit coalition authored the Insurance Fairness legislation, and has lobbied for its implementation for over a decade. Thus far, the legislation has been ratified in 20 states and received bipartisan support. 

Although the bill has not been attempted in Wisconsin yet, it is currently being drafted and awaits a formal introduction to the state Legislature by Rep. Robert Brooks, R-Saukville. 

The bill would potentially require all insurance policies within the state to provide coverage for prosthetics and orthotics equal to or better than the federal Medicare program. Additionally, it would abolish coverage caps and lifetime restrictions. 

“Really the goal [of the Insurance Fairness legislation] is to end discrimination and to have external prosthetics treated the same as internal prosthetics,” Faessler said. “Conceptually, it really is as simple as that.”

If the bill passes, Wisconsinites could see the per member per month cost of insurance increase by $0.12 to cover the cost of prosthetics for all, as determined by eight states’ independent studies.

“The consensus in each study found that the cost of care would be minimal and the benefit to the individual, their family, and society, would be significant,” the Amputee Coalition synthesized.

The current reimbursement for prosthetics in Wisconsin ranges from $1,000 to $5,000 with prices of some devices reaching upwards of $50,000, according to data from the Hospital of Specialized Surgery

Another barrier for amputees with private insurance plans is the common feature of “one prosthetic per lifetime” caps, which can be insufficient since prosthetics are not made to last a lifetime.

“But even then, the most expensive prosthetic limbs are built to withstand only three to five years of wear and tear, meaning they will need to be replaced over the course of a lifetime — and they’re not a one-time cost,” according to an ABC News article.

Until the bill is introduced to Wisconsin’s Legislature, Faessler and other activists will continue working towards the realization of the proposed law. 

“My bigger picture and vision is to raise the standard of care for people with limb loss and limb difference and eliminate the stigma that just because you’re missing a limb doesn’t mean you aren’t a whole person,” Faessler said.

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