Civil Rights, Affordable Healthcare Act, and Exploring Equal Access

Section 1557 of the Patient Protection and Affordable Healthcare Act (ACA) of 2010 is a health reform law that focuses on the following three primary objectives regarding accessibility standards.

• Reform insurance policies
• Expand Medicaid to the working poor
• Change medical decision-making policies

Before 2010, insurance companies could discriminate, price gouge, refuse services, and deny coverage without penalty. All of these are violations of accessibility standards and are explicitly prohibited by multiple federal laws. This is why the civil rights part of Section 1557 was created using four current statutes. 

• The Rehabilitation Act of 1973
• The Civil Rights Act of 1964
• The Education Amendment of 1972
• Age Discrimination Act of 1975

Section 1557 and Discrimination

Section 1557 prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs. So, this pertains to all medical providers, hospitals, nursing facilities, insurance providers, and those providing education on healthcare that receive partial or complete federal funding. 

So what does discrimination mean in this context? Regarding civil rights, discrimination refers to unfair or unequal treatment, inequality in providing access, or refusal to provide equal access to goods, services, information, or communication. 

Discrimination based on Disability

Discrimination based on a disability can occur knowingly and unknowingly. First, there is the outright refusal of service. This is easy to identify and relatively easy to avoid. However, refusing access to goods, information, and communication is not as easy to identify and can net costly mistakes. This happens because most facilities are only aware of the structural requirements when providing access for people with disabilities. 

A person with a disability can access a building, enter, and obtain items. Likewise, in theory, a person with a disability can contact a healthcare provider or insurance company and receive information. But, there is more to providing access. And this is the area where medical and insurance organizations make some of the biggest mistakes. 

Equal Access in Practice

Consider the following scenarios. What would be considered equal access? Which answer would you have to give if the situation occurred today? 

Patient is Blind

A woman with blindness is interested in comparing insurance plans. She asks for information regarding each program offered. 

1. Hand her a print format of all of the plans offered. Let her know you are happy to answer any questions and explain the programs.
2. Explain some of the plans you feel would best meet her needs.
3. Direct her to a company website.
4. Ask her if she requires an alternative to print format. And if she does, provide her with the requested information.
5. Ask her if she requires an alternative to print format and what it might be. Let her know you are ordering that information.

Parent Has a Disability

A child is in for a surgery consult. The father is given written instructions. The father indicates that he has a visual disability and cannot read the information. However, he was able to read other things. 

1. Ask him if there is someone who can read the information for him.
2. Briefly skim over the information highlighting the critical parts verbally.
3. Ignore the statement and let him know all of the information is basic, and he could probably manage.
4. Ask him what accommodations he requires to make the information readable. Then, provide him with the information.
5. Ask him if there is a different format that would make the information accessible. Then, let him know you will order the information.

Patient has Visual Disability

A person is interested in a product available from your company. However, it is only online. The person attempts to access the online resource but cannot navigate the site. The person sends an email and indicates that the online site is inaccessible to them. 

1. Tell them it must be a user error and to try again later.
2. Ask them what the product is and facilitate the purchase while gathering credit card and personal information.
3. Let the person know they can mail in a request for any products.
4. Provide the person a link that is accessible.
5. Apologize for the issue and let the person know you will immediately fix the situation. Then, remedy the issue.

Which answer did you choose?

These are all situations that happen to people with visual disabilities and blindness. The responses people often receive are A and B. However, the best legal answer is D, with E being a backup in some situations. 

Review how your company would handle each scenario.  Anything that doesn’t provide equal access violates a person’s rights and goes against accessibility standards. 

So, how did your organization do?

More to Consider Regarding Required Accessible Documents

What kind of documents need to be accessible?

All print and digital communications need to be accessible. This includes everything from office handouts to HIPAA forms and discharge instructions to emails.

Who qualifies for accessible documents?

A patient, caregiver, parent, spouse, or guardian with a disability can request all forms, instructions, billing, and the like in an accessible format. 

What makes a document accessible?

A person with a disability will request the accessible format they need. So, the key to a document being accessible is that the person with a disability can navigate and comprehend the information provided. These accessibility standards exist so they can make informed decisions regarding their healthcare, follow any precautions, and understand their rights.

The most common accessible documents are braille, large print, audio, and 508 or WCAG remediated digital documents, attachments, and emails. 

Is verbal instruction an accessible form of communication?

No, verbal instruction is not the same as accessible. 

Think of it this way: Patient A, who is sighted, receives written documentation. Patient B, who is blind, requests documents in braille, and receives verbal instruction. This violates the law because Patient A can access and reference the information later. Patient B has to rely solely on memory to revisit medical instructions. So, it is not difficult to see why accessible documents are vital in healthcare and insurance. 

Section 1557 Changes

There are frequent changes to portions of Section 1557 so it’s important to check the most recent version. You can find that on the U.S. Department of Health & Human Services‘ website. 

However, there is good news for people with disabilities. The latest rulings and opinions support and ensure physical access for individuals with disabilities to healthcare facilities. So, accessibility standards are improving. They also provide appropriate communication and technology to assist persons who are visually or hearing impaired.