Jim Young stood on a crate on the broad plaza outside the Department of Health and Human Services, a red megaphone in his right hand and, beneath his khaki shorts, an artificial left leg.
“Limbs, limbs are not a luxury!” he chanted, leading nearly 150 people clustered around him who were wearing prostheses and matching orange T-shirts that said on the back, “Medicare amputees deserve legs too.”
Wednesday afternoon’s modest protest was organized to attract outsize attention to concerns by the nation’s amputees — and health practitioners who work with them — that the government might make it more difficult for older and disabled Americans to afford state-of-the-art artificial legs, or any artificial legs at all.
Such changes are envisioned in a set of rules proposed by the four regional companies to which Medicare delegates responsibility for the program’s medical device benefits, including artificial limbs.
Under the proposed changes in Medicare coverage, patients with fresh amputations would need to wait to get their first “definitive” artificial leg until after rehabilitation therapy. And people could not get, or replace, technologically advanced prostheses if they rely at times on a walker or a cane — or if an artificial leg does not enable them to walk with a natural gait. Critics of the rules say that Medicare might be able to deny coverage of artificial legs to people with high blood pressure or other ailments.
If the changes go into effect, they would have the most direct effect on about 150,000 amputees among the 55 million Americans covered by Medicare, the half-
century-old federal health insurance program for people who are 65 and older or are disabled. The new rules would apply only to artificial legs, not arms or hands, but lower limbs account for the vast majority of amputations.
The proposals, however, have alarmed amputees of all ages, including younger people with private health insurance or other kinds of public coverage. “Medicare sets the tone and sets the precedent,” said Adrianne Haslet-Davis, a professional ballroom dancer who lost her left leg below the knee in the 2013 Boston Marathon bombing.
On Wednesday morning, she testified at a hearing in Baltimore before the medical directors of the federal contractors proposing the changes. By afternoon, she stood on the HHS plaza, giving interviews. “I understand they want to cut costs, but how they want to do it will devastate,” she said.
The new rules would be the first changes in Medicare benefits for amputees in the four years since the HHS inspector general questioned some of the program’s spending on prostheses. The report pointed out that, between 2005 and 2009, the most recent years for which data were available, the number of Medicare patients receiving artificial legs decreased slightly, while annual spending on those medical devices during that time increased by more than 25 percent, to $655 million.
The report found that in 2009, Medicare inappropriately paid $43 million for artificial legs for patients who did not meet the program’s coverage rules. And during the five-year span that the HHS investigators examined, Medicare paid an additional $61 million for prostheses in instances in which the program lacked evidence that a doctor had referred a patient for the device.
Thomas Fise, executive director of the American Orthotic & Prosthetic Association, said that the investigation did not take into account advances in artificial limbs as a result of injuries from the Iraq and Afghanistan wars — advances that have made prosthetics better but more expensive. He also said that Medicare spending on such devices has declined since 2010.
He was one of several protest leaders who met late Wednesday afternoon with senior officials of HHS and its Centers for Medicare and Medicaid Services. The agency does not set the coverage rules for artificial limbs but oversees the regional contractors who do.
After the meeting, Aaron Albright, a spokesman for the Medicare and Medicaid agency, said that the officials would work with the medical directors of the regional contractors to ensure that any rule changes are based on scientific evidence and do “not limit necessary services” for Medicare patients.
At Wednesday’s hearing in Baltimore, the medical directors did not say whether they might change their proposal — or when they plan to make a final decision.
That is the decision that Young and his fellow protesters hope to influence.
Young, a 52-year-old from Macon, Ga., was injured in a motorcycle accident while in the Air Force. He spent three years in a hospital and had 28 operations before doctors amputated his left leg above the knee. For a time, Medicare covered his artificial limb because he qualified as disabled. He went back to school and, since 2001, has worked as a prosthetist. He no longer is a Medicare patient because he is no longer considered disabled.
Good artificial limbs, he shouted into the megaphone, “are the way we can walk around, the way we can take care of our families.”
Around him, protesters held up white signs with blue lettering. “Hands off my legs,” one said. “I am an amputee. Medicare don’t forget me,” said another.