Every rehabilitation technology company in the state should invest whatever it takes to get 20 or 30 of their customers to the state capital for a peaceful demonstration. Nothing brings out the media like 200 people in wheelchairs carrying protest signs.

For years, the HME services industry has played by the rules—their rules. As Congress and various administrations tried to reduce health care costs by decreasing spending on the goods and services the industry provides, many of you responded to every call for action. In reality, there is little to show for these efforts.

Political action committees were formed, and campaign contributions were made to members on key Congressional committees in hopes that they would look favorably upon our industry and its role in health care. In return, the industry received massive reimbursement cuts.

Numerous “fly-ins” brought hundreds of industry advocates to Capitol Hill to educate Congress and the administration on the devastating effects of their policies. Congress and the administration responded by developing new, more restrictive eligibility requirements.

In an attempt to emulate the success of other special interest groups, dozens of high-priced lobbyists have been hired to plead the industry’s case. The results so far are onerous provisions such as competitive bidding and reductions in the allocation of Medicaid funds to the states.

For more than 15 years, the HME services industry has been a target. In part, the industry has itself to blame. Many providers were aware of competitors who were “gaming” the system, and said nothing. This led regulators to the inevitable conclusion (albeit inaccurate) that everyone in the industry was dishonest. As soon as progress was made to dispel this myth, a new story would break about a sleazy provider. The results: more scrutiny, more rules, regulations, and fines.

Despite its best efforts, the industry is not much better off today than it was 15 years ago! Some may argue that things are actually getting worse now that the states, following the federal government’s lead, are pursuing massive cuts in Medicaid funding and changes in Medicaid coverage policies.

This dark scenario is reminiscent of the battle fought by people with disabilities in the late 1970s and early 1980s. Despite federal law requiring that all public transit systems be “accessible to and usable by persons with disabilities,” it was virtually impossible for wheelchair users to ride the bus. This constituency also attempted to play by the rules. They arranged for sympathetic members of Congress to hold public hearings. Nothing happened.

With no resolution in sight, consumers marched on Washington. Rallies attended by 10,000 people with disabilities began to draw national attention to the issue but failed to stir the consciousness of Congress.

It became time to get militant. In peaceful protest, people who use wheelchairs surrounded the facilities where the American Public Transportation Association was having their meetings, effectively denying delegates access. Some transit operators began to get the message.

In numerous cities, wheelchair users chained themselves to buses, creating traffic jams and shutting down transit systems. Local TV stations and newspapers had a field day. Finally, lawsuits were filed and the federal courts ruled transit system after transit system in violation of federal law, ordering them to implement the plan to become fully accessible within 5 years.

The point of this walk through history is to help the industry understand that in addition to all its other efforts, they may have to get militant. If your state Medicaid program is effectively dismantling the benefits package so that coverage for appropriate mobility technology is impossible, take it to the streets. Every rehabilitation technology company in the state should invest whatever it takes to get 20 or 30 of their customers to the state capital for a peaceful demonstration. Nothing brings out the media like 200 people in wheelchairs carrying protest signs.

It is a little more difficult to get people to Washington, but it is not impossible to let their voices be heard. The industry should hire a professional production company to interview dozens of consumers from every congressional district and send that videotape to their representatives.

Finally, the industry should actively become involved with consumer groups, educating them about the consequences of proposed fee reductions and rule changes.

There are dozens of other ways to use civil disobedience, militancy, and consumers to articulate messages that can advance the concerns of the industry. All that needs to happen is for industry leaders to find the intestinal fortitude to use them.

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare Corp, Elyria, Ohio. David T. Williams is a consultant for political and legislative strategy.