Via Community News Service, a University of Vermont journalism internship
When Gage Pelletier lost his leg to osteosarcoma — a rare, aggressive type of bone cancer — during his freshman year of high school, he was told he would never be able to play hockey again.
Pelletier, now 20 years old, received a basic prosthetic leg when he was 15 after going through chemotherapy and an amputation. He couldn’t return to his favorite sport, so he turned to lacrosse instead. But insurance wouldn’t cover an additional prosthetic used for running, known as a blade.
“The lacrosse season went and was gone, and I lost all motivation to apply for it and figure everything out,” Pelletier told the House Committee on Health Care on Feb 3.
Pelletier was one of many people who testified in support of H.432, a tripartisan bill that would expand health insurance coverage for prosthetic and orthotic devices.
Under the bill, health insurance providers would be required to cover devices that are medically necessary for a patient’s basic needs and physical activities, such as running, biking and swimming. The bill also says that providers would not be able to deny coverage solely based on the person’s perceived needs.
The bill’s main sponsor, Rep. Mollie Burke, D-Windham-8, said she introduced the bill last year after hearing from David Hiler, a runner and amputee who represents Vermont for the nonprofit So Every BODY Can Move. The organization aims to pass legislation that improves coverage of orthotic devices in 28 states before the 2028 Paralympics.
Hiler, who also testified on Feb. 3, told lawmakers there are about 9,000 Vermonters living with a limb loss or difference, many of whom are unable to fully participate in work, recreation and daily life because of their insurance coverage.
“Not all of us can access everything Vermont has to offer due to the limitations of the coverage we get,” Hiler said. “There’s lots of functions the human body has, and one device just isn’t going to cut it.”
Hiler said insurance typically covers treatments needed to help people regain function of injured limbs. But people who lose limbs, or who are born without them, must rely on fundraising or grants to return to normal life, he said.
“All we’re asking for in this bill is fairness,” Hiler said.
Similar laws have passed in other states. In New Hampshire, for instance, it costs an extra one to five cents per month, per person to get upgraded coverage, Hiler said.
Specialized prosthetic devices can cost anywhere from $10,000 to $70,000, and increased insurance coverage could help Vermonters in the short and long term, according to Hiler.
“Active amputees, frankly, are healthier, happier and safer in their lives, which saves potentially thousands of dollars to insurance companies every year,” he said.
Jennifer Carbee, deputy chief counsel of the Office of Legislative Counsel, said lawmakers may need to consider whether H.432 would create a new insurance mandate under the Affordable Care Act. If so, the state would be responsible for covering the price of premium benefits, such as for a prosthetic.
“The state is on the hook to pay any additional premium amounts for qualified health plans that are attributable to that new benefit mandate,” Carbee said on Feb.19.
Lawmakers are continuing to discuss the bill and have not yet voted. Supporters of the bill, like Hiler, are hoping that H.432 will help eliminate the barriers that people without limbs face.
“Simply put, movement is medicine, and (being) physically active should be a right, not a privilege,” he said.