By David Smriga, MA

H.R. 3’s current language promotes a bias—intended or not—that mild-to-moderate hearing loss and severe-to-profound hearing loss are two distinct categories, requiring two distinct legislative treatments. Says who?

On April 18, 2017, the FTC held a workshop looking at hearing aids and over-the-counter (OTC) devices.1  Several panel presentations/discussions comprised this workshop.  One panel in particular was asked to speak to the costs and benefits of hearing healthcare regulations. The panel included representatives from IHS, AAA, the FTC, and the Consumer Technology Association.  At one point, the representative from the Consumer Technology Association stated the following [paraphrased]:

Look, consumers have a clear choice.  They can either choose well designed, well engineered, sophisticated devices designed to help them hear better, or…they can choose hearing aids.

Clearly, this statement was intended to be both provocative and damning. The speaker wanted his audience to believe a new reality: namely that the hearing aid industry has been poorly serving consumers for decades and that consumers don’t need that industry (or the professional care associated with it) to hear better.

Certainly, the statement was a deliberate affront. But what was more frustrating was that neither AAA or IHS panel members challenged or rebutted his clearly defamatory statement.  Left so unchallenged, his statement found a clearer path to becoming a new reality.

On December 12, 2019, the US House of Representatives passed H.R. 3 (the “Elijah Cummings Lower Drug Costs Now Act”) which includes Section 602 entitled, “Providing Coverage for Hearing Care under the Medicare Program.”2 Section 602 of the bill adds two new Medicare hearing benefits: 1) The provision of aural rehabilitation and treatment services by qualified audiologists, and 2) The inclusion of hearing aids for Medicare beneficiaries with severe-to-profound hearing loss.  The bill must now go through the Senate, where there is less appetite for negotiating lower drug prices.3

To be clear, H.R. 3 is proposing that all Medicare beneficiaries, regardless of degree of hearing loss, have access to Medicare-covered diagnostic and rehabilitative care as provided by an audiologist.  However, only Medicare beneficiaries with a severe-to-profound hearing loss will have access to the proposed hearing aid benefit. And, by some accounts, this represents less than 6% of the total hearing impaired population in the United States.4

So, what “reality” guided federal legislators to limit the hearing aid benefit to those with severe-to-profound hearing loss conditions? Consider the recommendations embodied in the 2015 PCAST (President’s Council of Advisers on Science and Technology) report5 which included the following statement:

“The FDA should designate a distinct category of ‘basic’ hearing aids – non-surgical, air-conduction hearing aids intended to address normal, bilateral, gradual onset, mild-to-moderate age-related hearing loss …, and should approve this class of hearing aids for over-the-counter sale, without the requirement for consultation with a credentialed dispenser…”6

This view of reality suggests that those with mild-to-moderate hearing loss don’t need the kind of hearing aids that those with severe-to-profound hearing loss need. Those with mild-to-moderate hearing losses can fit themselves with OTC products. But, those with severe-to-profound hearing losses need professional consultation and more traditional “hearing aids.” 

Could this be the viewpoint that guided the writers of H.R. 3 to limit the “hearing aid” benefit to those with severe-to-profound hearing loss— a viewpoint crafted by a council whose membership included no one from the consuming public or within the hearing health care industry or professions?

We can’t know for sure.  But, what we do know is that this notion of drawing a line between mild-to-moderate hearing loss (however defined) and severe-to-profound hearing loss (however defined) as a pivot point in determining the need for a hearing aid benefit (and implicitly the need for associated professional hearing health care) did not come from consumers, nor did it come from the hearing health care community. It came from outside forces. Outside forces clearly interested in crafting a new reality.

In fact, consumer opinion about the importance of professional involvement in hearing health decisions and purchases, regardless of degree of hearing loss, is quite emphatically different.

Consider, for example, the results of consumer surveys conducted by the editors at HealthyHearing.com.7  A total of 809 survey participants aged 50 years and older were selected from a nationwide panel of more than 30 million people that was balanced to be representative of the US population. The large sample size resulted in a small (3.45 percent) margin of error. A small margin of error indicates that the survey is likely to be a representative sample of Americans in this age group. The vast majority of respondents reported having normal hearing ability. Of those who reported hearing loss, only 28% wore hearing aids.  Therefore, the majority of respondents had little hearing aid experience—the presumed target market for OTC hearing aids. Some examples of the survey responses include the following:

If you needed a hearing test, how important do you think it would be to have a hearing care professional thoroughly evaluate your hearing loss and make recommendations?

  1. 59.70% – absolutely important
  2. 33.62% – very important
  3. 5.19% – of average importance
  4. 0.62% – of little importance
  5. 0.87% – not important at all

If you needed hearing aids, how important do you think it would be to have a hearing care professional select, fit and program hearing devices specifically for your needs?

  1. 60.32% – absolutely important
  2. 33.50% – very important
  3. 4.45% – of average importance
  4. 1.11% – of little importance
  5. 0.62% – not important at all7

In addition, MarketTrak 9 data8 indicates that 85% of hearing aid users who have hearing aids 4 years old or newer are satisfied with their devices, and 90% of those owners are satisfied with the professional care they received. All while most of these users have a mild-to-moderate hearing loss.4

So, regardless of the degree of hearing loss, or any prior experience with hearing healthcare, it seems evident that the general population of consumers feel professional care and guidance is an important component in effectively treating any degree of hearing loss, and that receiving such care is overwhelmingly satisfying, even for those with mild-to-moderate hearing loss. In addition, considering the co-morbidities now inexorably tied to other-than-normal hearing conditions,9 the most effective treatment would seem to be in the consumer’s best overall health interests.

Unfortunately, H.R. 3’s current language promotes a bias—intended or not—that mild-to-moderate hearing loss and severe-to-profound hearing loss are two distinct categories, requiring two distinct legislative treatments.

Says who?

If not the consumer, and if not those who provide professional hearing healthcare, then these very constituencies must demand an explanation from legislators as to what led them to this distinction. Especially before this distinction becomes actual law.

Because, if an opinion goes unchallenged, it gains a clearer path to becoming a new reality.

Acknowledgement

This article was originally published on the AudNet Hearing Group website and appears here with the permission of the author.

References

1. Strom KE. FTC Workshop Looks at Hearing Aids and OTC Hearing Devices. April 19, 2017. Available at: https://www.hearingreview.com/inside-hearing/industry-news/ftc-workshop-looks-hearing-aids-otc-hearing-devices

2. 116th US Congress. H.R.3 – Elijah E. Cummings Lower Drug Costs Now Act, Sec 602: Providing Coverage for Hearing Care Under the Medicare Program. September 19, 2019. Available at: https://www.congress.gov/bill/116th-congress/house-bill/3/text#toc-HFC28125AF7654AF7AC6366E440AD29CD

3. Hearing Loss Association of America (HLAA). Breaking News: House Passes Bill for Medicare Coverage of Hearing Aids. December 13, 2019. Available at: https://www.hearingloss.org/house-passes-bill-for-medicare-coverage-of-hearing-aids/

4. Goman AM,  Lin FR. Prevalence of hearing loss by severity in the United States. Am J Public Health. 2016 October; 106(10): 1820–1822.

5. PCAST Recommends Creation of “Basic” OTC Hearing Aid Category; Easing of PSAP Regulations. October 23, 2015. Available at: https://www.hearingreview.com/inside-hearing/industry-news/pcast-report-hearing-loss-raises-concerns

6. President’s Council of Advisors on Science and Technology (PCAST). Aging America & Hearing Loss: Imperative of Improved Hearing Technologies. October 2015. Available at: https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/PCAST/pcast_hearing_tech_letterreport_final.pdf

7. Plotnick B, Dybala P. OTC hearing aids—Survey says consumers aren’t sold. April 6, 2017. Available at: https://www.healthyhearing.com/report/52742-Otc-hearing-aids-survey-says-consumers-aren-t-sold

8. Abrams HB, Kihm J. An introduction to MarkeTrak IX: A new baseline for the hearing aid market. Hearing Review.2015;22(6):16-21.

9. Deal JA, Reed NS, Kravetz AD. Incident hearing loss and comorbidity: A longitudinal administrative claims study. JAMA Otolaryngol Head Neck Surg. 2019;145(1):36-43.

David J. Smriga
David J. Smriga, MA

About the author: David J. Smriga, MA, is Vice-President of Corporate Communications for AUDNET Hearing Group, a national organization of hearing health care entrepreneurs focused on supporting small business excellence in the hearing care industry. 

Correspondence can be addressed to HR or David Smriga at: dave@audnethg.com.