Dr. Kahn’s patient, Peggy, needs an oxygen concentrator, ventilator and nebulizer at home, critical medical equipment. For people like Peggy, who rely on specialized medical equipment for life support, being cut off from public services can be life-threatening. , utility bills are always a top priority. Living without oxygen or a ventilator is not an option for her.
Every year, millions of households are cut off from public services because they can’t afford to pay their monthly bills. Utility outages can harm any home, but they are especially dangerous for medically vulnerable individuals like Peggy. increase.
To avoid such tragic consequences, most states offer some protection against closure for medically vulnerable individuals. found that “many existing state laws and regulations either create protections that are overly narrow, difficult to access and not widely known, or provide overly short terms.” protection period. “
Recently published data on Michigan’s health care protection program rarely saw some of the challenges of existing programs. Michigan offers her two types of protection to medically vulnerable people. So-called “critical care customers,” people who depend on life-sustaining medical equipment and whose loss of service would be “immediately life-threatening,” can apply annually for utility outage protection. A person who does not meet the criteria for critical care may apply for an “emergency medical” exemption if the condition is aggravated by the loss of services. However, this exemption period is only 21 days, and one person can receive protection only three times a year.
Both programs require applicants to provide a certificate signed by a medical professional. However, the decision to approve the application is ultimately made by the utility company. Additionally, key terms such as “immediately life-threatening” are not defined, which could lead to restrictive interpretation of the regulation by utilities.
In July, a task force run by Michigan’s utility regulator released data on the implementation of the program, and the numbers are staggering. DTE, an electric and gas company serving about 2.3 million customers in the Detroit area, has denied nearly 70% of his medical emergency program applications between 2019 and 2021. In the same period he has 3 applications.
Denial rates for critical care programs were more evenly matched, but remained embarrassingly high, with about 35% of people seeking protection denied in 2021.
It’s not clear from the data why so many people are denied protection in Michigan, but it ultimately misses the point. Unnecessary distress can occur when health care protection decisions are made by parties other than health care providers with the patient’s best interests in mind.
Common sense reforms can vastly improve health protection programs like Michigan’s and save lives. First and foremost, medical professionals must take sole responsibility for determining whether a person’s condition is at risk for shutdown. must be deterministic.
In the event of a dispute, the utility must formally challenge the application before the utility regulator. If the Company substantively challenges a client’s physician, it must provide testimony from an independent, third-party medical professional. This approach shifts the burden of justifying denial onto the utility, reducing the pressure on those experiencing medical difficulties.
Other best practices identified in the NCLC report can further improve these programs. For example, application forms should be short, easy to understand and complete, and available in multiple languages. More and higher quality data reports, ideally by zip code, are also important to understand what is happening and why.
Regulators and public entities can also explore ways to automate registration. For example, working with health care providers to provide automatic protection for patients receiving life-supporting medical devices.
Additionally, utilities and regulators need to consider how to deal with the debt that accumulates while people are on board. A medical protection program eliminates the immediate threat of suspension, but monthly charges continue to accrue during the protection period. When households fall behind in payments, debt can accumulate to unmanageable levels. The problem requires other solutions, such as offering discounts on electricity bills to customers with home medical equipment or offering a way out of debt through debt amortization programs.
For medically vulnerable individuals like Peggy, continued access to public services can be a matter of life and death. With the increasing complexity of medical devices and the move to move healthcare into the home environment, the need for medical protection is expected to increase significantly over time. Ensuring continued access to public services in such circumstances is not only a matter of sound public health, but also a fundamental human right.
Sam Whillans is Co-Director of the Yale Environmental Conservation Clinic at Yale Law School and a Fellow of the Natural Resources Defense Council. He addresses issues related to access and affordability to climate, housing and utilities. The above information is provided for identification purposes only. The views expressed herein do not represent those of the Yale Environmental Conservation Clinic, Yale Law School or NRDC.
Charlie Harak is a senior attorney for energy and utility matters at the National Consumer Law Center. He represents consumers before regulatory bodies, testifies at legislative hearings, and provides legal and policy advice to low-income advocates, legal service attorneys, and government officials. He is the co-author of “”.Protecting Critically Sick Consumers from Utility Outages: What States Can Do Now to Save Lives”(February 2021).
Dr. Peter Kahn is a Fellow in the Pulmonary, Critical Care and Sleep Medicine Section at Yale Medical School. He graduated with honors from the Albert Einstein School of Medicine and Johns Hopkins He earned his MPH in Health Policy and Management from the Bloomberg School of Public Health. Dr. Khan’s research has focused on health policy, with particular interest in the impact of climate change and utilities on health policy. follow him on twitter @Peter KahnMD
