One would think a proposal to deregulate the hearing aid market would be embraced by free-market advocates. And yet conservative groups are pushing back on a bill that would do just that, putting themselves firmly in the camp of hearing aid manufacturers.
Several senators, including Susan Collins (R-Maine) and Elizabeth Warren (D-Mass.), have sponsored the Over-the-Counter Hearing Aid Act of 2017, which would allow companies to sell hearing aids for mild to moderate hearing loss over-the-counter, without requiring consumers to go through a licensed audiologist. It is now a provision of a larger must-pass bill, but that hasn’t deterred groups representing audiologists and incumbent hearing aid manufacturers from making a last ditch attempt to squash it.
Under the status quo, state-level licensing boards grant audiologists hearing aid dispensing privileges, requiring consumers to pay additional fees for an evaluation, to have the hearing aid fitted, and restricting competitive entry into the national market. What’s more, audiologists often have exclusive contracts with manufacturers to sell just a handful of hearing aid models, slowing the pace of innovation.
Advocacy groups representing both the audiological community and manufacturers have come out against the Act citing safety concerns, but they are likely also fearful of increased competition. In a report, the National Academy of Sciences argued that the benefits of increased competition in hearing aids vastly outweigh any safety risks, which explains why the bill has received ringing endorsements from the AARP and the Hearing Loss Association of America — groups that actually represent end users.
That manufacturers would be opposed to this bill isn’t surprising. The unexpected twist is that self-described free market and conservative groups have been the main source of public opposition. In addition to a flurry of outraged op-eds, a coalition of about 20 conservative advocacy groups recently cosigned a letter to Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor and Pensions Committee, urging him to reject the proposal.
The Act, the letter claims, is a big government ploy in disguise, intended to increase regulation on Personal Sound Amplification Products, the unregulated hearing technologies intended for the non-hearing impaired to amplify environmental sound, or for hearing the television with the volume turned down. Yet FDA medical device regulation only applies to products that market themselves as intended to compensate for hearing loss, and that’s not about to change.
The fears ginned up by the coalition were nonetheless effective at persuading the Gun Owners of America that their hunting PSAPs were under threat, amusingly turning hearing aid deregulation into a Second Amendment issue. They have since backed off their opposition after receiving assurances from bill’s authors.
U.S.-based hearing aid manufacturer, Starkey Hearing Technologies, reportedly “spent $50,000 lobbying on the issue in the first three months of this year — the first time in a decade the company has spent money on lobbying.” That conservative groups have allied with industry — because conservative enemy Warren supports the bill — is an ominous sign for Republicans, who have long argued that deregulation and competition should be at the center of bipartisan health care reform.
Groups like the Consumer Technology Association support the bill because it would create a path for innovative new hearing aids to enter the national market. Similar to direct-to-consumer eyeglasses and contact lenses, the bill could also spur the emergence of online tools for self-evaluating hearing loss — a potential boon for rural communities with limited access to hearing doctors.
Roughly 1 in 5 Americans over the age of 12 suffer from some degree of hearing loss. Despite the advanced technology available, less than 15 percent of people eligible for hearing aids purchase them. There are various reasons for this, but an important one is affordability. The average pair of mid-line prescription hearing aids costs between $2,000 and $3,400. This problem is compounded by the fact that traditional Medicare and many private insurance companies don’t cover hearing aids.
Opening the market to OTC hearing aids would force the industry to cut prices and compete head-to-head against newer technologies. For a bill that is virtually an archetype for market-based health care reform, continued conservative opposition communicates a distressing case of partisanship over principle.
Samuel Hammond is a poverty and welfare analyst at the Niskanen Center. He previously worked as an economist for the government of Canada where he specialized in rural economic development. Katy Li is a poverty and welfare intern at Niskanen Center. She is also a political science major and social policy minor at Johns Hopkins University.
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