Tag Archives: Affordable Care Act

“Long COVID” as a Disability Under the Americans with Disabilities Act, Section 504, and Section 1557

August 5, 2021 By in Coronavirus, Federal Agencies, MEDical Tags: , , , , , , ,

 

 

Late last month, HHS/Office of Civil Rights and DOJ/Civil Rights Division Disability Rights Section released its guidance for “long COVID” or “long haulers”.

Although many people with COVID-19 get better within weeks, some people continue to experience symptoms that can last months after first being infected, or may have new or recurring symptoms at a later time.1 This can happen to anyone who has had COVID-19, even if the initial illness was mild. People with this condition are sometimes called “long-haulers.” This condition is known as “long COVID.”2

The new guidance explains that long COVID can be a disability under the ADA, Section 504 of the Rehabilitation Act of 1973, and Section 1557 of the Affordable Care Act, and explains how these laws may apply. Each of these federal laws protects people with disabilities from discrimination.

1. What is long COVID and what are its symptoms?

According to the Centers for Disease Control and Prevention (CDC), people with long COVID have a range of new or ongoing symptoms that can last weeks or months after they are infected with the virus that causes COVID-19 and that can worsen with physical or mental activity.8 Examples of common symptoms of long COVID include:

• Tiredness or fatigue
• Difficulty thinking or concentrating (sometimes called “brain fog”)
• Shortness of breath or difficulty breathing
• Headache
• Dizziness on standing
• Fast-beating or pounding heart (known as heart palpitations)
• Chest pain
• Cough
• Joint or muscle pain
• Depression or anxiety
• Fever
• Loss of taste or smell

This list is not exhaustive. Some people also experience damage to multiple organs including the heart, lungs, kidneys, skin, and brain.

2. Can long COVID be a disability under the ADA, Section 504, and Section 1557?

Yes, long COVID can be a disability under the ADA, Section 504, and Section 1557 if it substantially limits one or more major life activities.9 These laws and their related rules define a person with a disability as an individual with a physical or mental impairment that substantially limits one or more of the major life activities of such individual (“actual disability”); a person with a record of such an impairment (“record of”); or a person who is regarded as having such an impairment (“regarded as”).10 A person with long COVID has a disability if the person’s condition or any of its symptoms is a “physical or mental” impairment that “substantially limits” one or more major life activities. This guidance addresses the “actual disability” part of the disability definition. The definition also covers individuals with a “record of” a substantially limiting impairment or those “regarded as” having a physical impairment (whether substantially limiting or not). This document does not address the “record of” or “regarded as” parts of the disability definition, which may also be relevant to claims regarding long COVID.

a. Long COVID is a physical or mental impairment

A physical impairment includes any physiological disorder or condition affecting one or more body systems, including, among others, the neurological, respiratory, cardiovascular, and circulatory systems. A mental impairment includes any mental or psychological disorder, such as an emotional or mental illness.11 Long COVID is a physiological condition affecting one or more body systems. For example, some people with long COVID experience:

• Lung damage
• Heart damage, including inflammation of the heart muscle
• Kidney damage
• Neurological damage
• Damage to the circulatory system resulting in poor blood flow
• Lingering emotional illness and other mental health conditions

Accordingly, long COVID is a physical or mental impairment under the ADA, Section 504, and Section 1557.12

b. Long COVID can substantially limit one or more major life activities

“Major life activities” include a wide range of activities, such as caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, sitting, reaching, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, writing, communicating, interacting with others, and working. The term also includes the operation of a major bodily function, such as the functions of the immune system,
cardiovascular system, neurological system, circulatory system, or the operation of an organ. The term “substantially limits” is construed broadly under these laws and should not demand extensive analysis. The impairment does not need to prevent or significantly restrict an individual from performing a major life activity, and the limitations do not need to be severe, permanent, or long-term. Whether an individual with long COVID is substantially limited in a major bodily function or other major life activity is determined without the benefit of any medication, treatment, or other measures used by the individual to lessen or compensate for symptoms. Even if the impairment comes and goes, it is considered a disability if it would substantially limit a major life activity when the impairment is active. Long COVID can substantially limit a major life activity. The situations in which an individual with long COVID might be substantially limited in a major life activity are diverse. Among possible examples, some include:

• A person with long COVID who has lung damage that causes shortness of breath, fatigue, and related effects is substantially limited in respiratory function, among other major life activities.
• A person with long COVID who has symptoms of intestinal pain, vomiting, and nausea that have lingered for months is substantially limited in gastrointestinal function, among other major life activities.
• A person with long COVID who experiences memory lapses and “brain fog” is substantially limited in brain function, concentrating, and/or thinking.

Read more here.

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H.R. 1368: No Healthcare Subsidies for Foreign Diplomats Act of 2015

March 18, 2015 By in Federal Agencies, Follow the Money, Foreign Assistance, John F. Kerry, MEDical, Oversight, Secretary of State, State Department Tags: , , , , , , , , , 2 Comments

Posted: 12:12 am EDT
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Following the 2013 report that Russian diplomats were charged with alleged widespread Medicaid fraud between 2004 to 2013 at an approximate cost of $1,500,000 in fraudulently received benefits (see 49 Russian Diplomats/Spouses Charged With Picking Uncle Sam’s Pocket in Medicaid Scam), Congress investigated (Congress Seeks Information on Obamacare Coverage of Foreign Diplomats).

On March 17, the House Committee on Foreign Affairs announced  that U.S. Rep. Ed Royce (R-CA), Chairman of the House Foreign Affairs Committee, and U.S. Rep. Paul Ryan (R-WI), Chairman of the House Ways and Means Committee, introduced H.R. 1368, the No Healthcare Subsidies for Foreign Diplomats Act of 2015, legislation to prevent foreign diplomats from receiving subsidized health coverage under the Affordable Care Act (ACA).  According to the Department of Health and Human Services, foreign diplomats and United Nations employees in the United States are currently eligible to obtain American taxpayer-funded subsidies under the ACA, such as premium tax credits and cost-sharing reductions, just like American citizens and lawful permanent residents.  By contrast, U.S. diplomats overseas do not depend on foreign taxpayers for health care coverage, relying instead on domestic health insurance plans that provide overseas coverage.

Chairman Royce said: “After a year-long investigation, the Obama Administration finally came clean about the fact that foreign diplomats are eligible for taxpayer-funded health care subsidies.  This is unacceptable.   Americans’ tax dollars should not be used to foot the bill for foreign diplomats’ health care coverage.  I am pleased to reintroduce this legislation and look forward to working with Chairman Ryan to pass this commonsense reform.”

H.R. 1368:

  • Expresses the sense of Congress that foreign diplomats should be allowed to purchase health insurance coverage in the U.S., but the cost of that coverage should be borne by their sending States;
  • Expresses the sense of Congress that U.S. taxpayers should not subsidize the health insurance expenses of foreign diplomats;
  • Amends the Internal Revenue Code to make foreign diplomats ineligible for health insurance premium tax credits and cost-sharing reductions under the ACA;
  • Requires the Secretary of HHS to certify to Congress that no foreign diplomats are receiving such benefits under the ACA; and
  • Requires the Secretary of State to notify all foreign missions in the U.S. that their personnel are ineligible for these benefits under the ACA.

The Committee says that initially, it sent a letter to Secretary Kerry requesting information on the arrest and the eligibility of foreign diplomats receiving government-funded medical benefits.  In January and April of 2014, the Committee also sent letters to the Secretary of Health and Human Services regarding foreign diplomats’ eligibility to receive Obamacare.  In a response on September 30, 2014, HHS confirmed foreign diplomats’ eligibility for government subsidized healthcare.  In October of 2014, Chairman Royce and former Chairman Camp wrote to IRS Commissioner John Koskinen seeking information about how many foreign diplomats have enrolled in the Affordable Care Act and have received subsidies.

The HHS response to the eligibility of foreign diplomats under Obamacare notes the following:

[F]oreign diplomats’ eligibility to participate in the Health Insurance Marketplaces is governed by the Affordable Care Act, which specifies that, in order to enroll in a qualified health plan (QHP) through the Marketplace, an individual must: (I) reside in the state that established the Marketplace; (2) not be incarcerated, other than pending the disposition of charges; and (3) be a United States’ citizen or national, or a non-citizen who is lawfully present and reasonably expected to remain so for the entire period for which enrollment is sought. Non-immigrant, non-citizens in the “A” and “G” visa classifications are lawfully present for this purpose, if they have not violated the terms of the status under which they were admitted or to which they have changed after admission. Accordingly, to the extent that a foreign diplomat who is a non-immigrant under an “A” or “G” visa classification and who has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission resides in the state that established the Marketplace and is not incarcerated other than pending the disposition of charges, he or she would be eligible for enrollment in a QHP through the Marketplace. The Department does not collect data on the number of foreign diplomats who participate in the Marketplace.

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Congress Seeks Information on Obamacare Coverage of Foreign Diplomats

October 30, 2014 By in Congress, Federal Agencies, Follow the Money, State Department, U.S. Missions, Visas Tags: , , , , , , , , ,

— Domani Spero
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On October 29, 2014,  the House Foreign Affairs Committee Chairman Ed Royce (R-CA) and Ways and Means Committee Chairman Dave Camp (R-MI) wrote to IRS Commissioner John Koskinen seeking information after learning that foreign diplomats working in the United States are eligible for subsidized health coverage under the Affordable Care Act (ACA). Excerpt from their letter:

The Committees on Foreign Affairs and Ways and Means are investigating the extent to which these diplomats receive taxpayer-subsidized premium tax credits and cost-sharing subsidies under the Affordable Care Act.  We are seeking to determine how many such individuals participate in these programs and the total cost of such benefits.  As the agency principally responsible for administering health coverage tax credits, we request that you provide this information as soon as possible.

According to the Department of Health and Human Services, foreign diplomats holding “A” or “G” visas are eligible to participate in an array of medical programs administered by the federal government, including participation in Health Insurance Marketplaces governed by the Affordable Care Act (ACA). The Secretary of Health and Human Services has informed the Committee on Foreign Affairs that, if they meet basic ACA requirements, “a foreign diplomat could satisfy the statutory criteria to be eligible for a premium tax credit and cost-sharing reductions.”  The State Department has gone so far as to advertise to Foreign Missions, Permanent Missions to the United Nations, and the United Nations Secretariat that health care exchanges and “the benefits of the United States Affordable Care Act are available” to them.

The Foreign Affairs Committee has sought to determine the number of diplomats receiving coverage and subsides under the ACA.  Unfortunately, the State Department has informed the Foreign Affairs Committee that it “is not involved in the process through which foreign diplomats obtain government-funded benefits” and cannot provide that data.  The Department of Health and Human Services is likewise unable to provide this information.  Specifically, it noted that “[t]he Department does not collect data that identify whether individuals receiving services through our medical programs have diplomatic status.”  Similarly, “the Department does not collect data that identifies whether individuals receiving tax credits and/or cost sharing reductions have diplomatic status.”  Copies of these letters are attached for your reference.

We fully support the ability of foreign diplomats to purchase health care coverage in the United States.  We do not, however, believe that American taxpayers should subsidize these services.  To assist with our oversight of this matter, we ask that you please provide the following information as soon as possible, but not later than 5:00 p.m. on November 12, 2014.

  1. The total number, including from which country, of all non-immigrant, non-citizen “A” and “G” visa holders who are eligible for, and who have received, premium tax credits for qualified health plans under the Affordable Care Act;
  1. The total number, including from which country, of all non-immigrant, non-citizen “A” and “G” visa holders who are eligible for, and who have received, cost-sharing reductions for qualified health plans under the Affordable Care Act; and
  1. The total cost, and cost per individual, of all subsidies provided to the individuals above.

The signed letter and referenced attachments are available here.

Did you know about this? Do you know the rationale for this?  International relations is based on reciprocity, are our American diplomats eligible for healthcare subsidies in countries that avail of Obamacare subsidies here? Since the State Department is “is not involved in the process through which foreign diplomats obtain government-funded benefits,” in the United States, how is it supposed to press countries for reciprocal treatment on behalf of our diplomats?

According to a notice circulated (pdf) by the State Department in February 2014, individuals who are lawfully present in the United States, including U.S. citizens, permanent residents (green card holders), and “A” and “G” visa holders (principal or dependent), may purchase coverage through the health insurance marketplace/exchange. Additionally, the notice states that “Those Permanent Missions whose employees do not receive health and medical insurance benefits through the sending state, or Permanent Missions who have not entered into a health and medical insurance plan with a private insurance provider, may find the benefits provided by the ACA a cost effective way to insure their employees against high physician, hospital, and prescription drug costs.”

Note that A-1 – 2 visas are for foreign government diplomats and officials and their immediate family members while G-1 – 4 visas are for international organization officials and employees and their immediate family members.

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-02/20/14   OAS Note No. 07-B: OAS Affordable Care Act Guidance  [98 Kb]
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-11/26/13   USUN Diplomatic Note HC-115-(S)-13: UN Secretariat Affordable Care Act Guidance  [43 Kb]
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