A lot of ink – digital and otherwise – has been spilled over the Affordable Care Act in the last several months and years. With the disastrous rollout of Healthcare.gov, many questions were raised about the viability of the program. I do not want to rehash any of these arguments or speculate about what the future will bring. However, I fervently hope that Obamacare succeeds, because it will have the dual effect of making my job easier and the lives of my clients better.
When you file an application for Social Security disability benefits, you bear the burden of proving to the Administration that you meet the requirements for benefits. SSA will help you obtain medical records, but if you’re not in medical treatment, there are no records to obtain. If you don’t have health insurance, it’s very difficult to get treatment. While there are some providers and clinics who provide treatment on a sliding scale payment basis, the medical records produced at these encounters are often of little use in a disability proceeding.
Why don’t the disabled have health insurance? They don’t have insurance because one generally gets health insurance from an employer, and the disabled (as defined by SSA) are not working. Even if they did have coverage while employed, it is usually lost once they have to stop working. It’s true that the disabled can opt to keep their coverage through COBRA, but this is very expensive and often unaffordable. Some disabled individuals can obtain coverage under their spouse’s plan, but this is too often not an option – either spousal coverage is not offered or it is too expensive.
Even if an individual elects to continue his coverage through COBRA, he may not be able to keep the coverage for the entire duration of the application process. It generally takes the Administration between four and six months to make an initial determination. If you’re denied (approximately 66% of all claims are denied initially), you must appeal. In most states, this is called a request for reconsideration and takes another two to three months. If you’re denied, like 90% of those who request reconsideration are, you must appeal again and request a hearing. In some states, including New York, the reconsideration step has been eliminated and you request a hearing right after the initial denial.
Waiting for a hearing is a lengthy process – at about a third of the nation’s hearing offices, it takes over 400 days to have your case heard and a decision rendered. Even the fastest hearing offices take over 200 days on average to render a decision. While your claim is pending, it is crucial that you continue to accumulate evidence, because most claims are for ongoing benefits. If you don’t have up-to-date evidence showing a disabling condition, your claim could be denied or you could only be granted benefits for a limited period of time.
The ACA guarantees access to the healthcare system for the disabled. This has several benefits – it allows those who are disabled to receive care for their impairments and thus to prove that they are disabled. It also allows many individuals to receive care for chronic conditions that, if properly managed, will not progress to the point that they become disabling.
While the ACA is certainly not a panacea, it provides much-needed access to individuals who may otherwise be unable to get the care they need. It is my hope that improving access to health care will allow for speedier, more accurate disability determinations, and more importantly, allow many to manage and control chronic conditions before they reach the point that they are disabling.
