U.S. Rep. Ayanna Pressley introduced a bill in the U.S. House last week that aims to speed up repairs for wheelchair users across the country.
The legislation would remove the requirement that insurance providers pre-approve fixes for people enrolled in Medicare Advantage — which covers 35 million Americans. Unlike traditional Medicare, Medicare Advantage requires prior authorization for most repairs and maintenance.
“For years my office has been hearing about this injustice that wheelchair users were experiencing,” Pressley, a Democrat who represents Massachusetts’ 7th District, told GBH News. “If you break your leg and you go to the ER, they’re not waiting for preauthorization before they start to set your leg. The same is true here. This is a major challenge for wheelchair users.”
Wheelchair users across the country say it’s common to wait months and in some cases more than a year to get their wheelchair repaired. In the meantime, even a simple part breaking can cause them to get stuck in bed, miss work and threaten their health.
“When a wheelchair breaks down, your life is on hold,” Pressley said. “You can’t get out of bed easily, cook a meal, go outside, just be your full selves. It robs you of your self-agency, your independence.
“If you’re a wheelchair user, having your wheelchair repaired and repaired quickly is not a nice-to-have, it’s essential,” she added.
Many wheelchair users say the problem has gotten worse in recent years as firms backed by private equity have bought up repair companies, meaning the market is dominated by just two companies. They also point to a long and bureaucratic insurance approval process.
The House bill comes as Massachusetts legislators are considering a separate state bill on Beacon Hill that would require companies to finish repairs from start to finish in 10 business days, modeled after a similar bill passed in Connecticut.
The National Coalition for Assistive and Rehab Technology, a nonprofit that represents the repair companies, supports the federal legislation because it aligns Medicare Advantage with Medicare when it comes to insurance approvals. The nonprofit’s executive director Wayne Grau says it can take up to three weeks for Medicare Advantage plans to decide on a repair authorization.
“CMS, which oversees Medicare, found it did not make sense to have consumers wait for paperwork to clear before getting their equipment repaired, because the original equipment was already prior authorized, so there was no need to duplicate the prior authorization process,” Grau, said. “Medicare Advantage plans should be held to the same standard.”
Several members of the Massachusetts congressional delegation, including U.S. Reps. Seth Moulton and Lori Trahan, are co-sponsors of Pressley’s bill.
Kelley Simoneaux, a wheelchair user and founder of the Washington, D.C.-based Spinal Cord Injury Law Firm, said she was glad to see federal lawmakers taking the delays seriously. Her firm has conducted surveys across the country to learn more about wheelchair users’ experiences.
“A lot of people are really becoming more vocal because of how the timelines are getting worse, not better, every year,” Simoneaux said. “The inequities that are being placed within an already very marginalized community is quite significant ... we certainly are existing in a broken system.”
But the real culprit in long wait times, she argues, is private equity.
U.S. Sen. Elizabeth Warren of Massachusetts has called out private equity’s influence on wheelchair repair companies and urged the federal government to do more. Two companies — Numotion and National Seating & Mobility, or NSM — have come to dominate the repair industry in recent years, leaving wheelchair users with few options and little recourse.
“Wheelchair users are just the latest victims of a private equity takeover that’s jacked up prices and delayed care for millions of patients,” Warren said in a statement to GBH News. “Instead of protecting patients, Donald Trump has let private equity trample all over our health care system. It’s time to hold these companies accountable for putting profits over patients.”
Simoneaux, an attorney, has used a wheelchair for 25 years and says she often goes to a bike shop to get help with repairs. Recently her chair was damaged by an airline, and she waited almost nine months to get it repaired. She pins that problem on private equity.
“The majority of that time delay is precisely in the hands of Numotion and National Seating & Mobility,” she said. “Ultimately it’s up to these companies to do right by our community.”
