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Addressing Chronic Conditions

Schmitt v. Kaiser Foundation Health Plan of Wash.


Schmitt v. Kaiser Foundation Health Plan of Washington (U.S. Court of Appeals, 9th Circuit, July 14, 2020) – The 9th Circuit Court of Appeals found Kaiser Health Plan did not violate the Affordable Care Act’s (ACA) discrimination provisions by failing to provide Plaintiffs with proper hearing loss treatment because the Plan did not categorically exclude coverage of hearing loss treatment. Plaintiffs alleged discrimination by arguing that hearing loss is a proxy for hearing disability, and that all individuals with hearing disability have hearing loss because the definition of “disability” includes “a physical or mental impairment that substantially limits one or more major life activities.” The court questioned whether the proxy’s “fit” was “sufficiently close” to make a discriminatory inference plausible. Since not all hearing loss is substantial, the court reasoned, “at least some individuals with that condition are not deemed disabled.” Therefore, while the insurer’s coverage of cochlear implants was inadequate to serve plaintiffs’ health needs, it might adequately serve the needs of hearing disabled people as a group. Read the full opinion here.  

View all cases in the Judicial Trends in Public Health – October 15, 2020.

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