Future Tense

A Simple Piece of Technology Will Help Millions of Americans, Thanks to a New Biden Policy

A collage of ears wearing hearing aids.
Photo illustration by Slate. Photos by Getty Images Plus.

Three years ago, on a random summer’s day, I suddenly lost all of the hearing in my right ear. I’d been sitting at my office desk, listening to Cam’ron through a set of janky earphones, when I noticed the sound from one bud getting softer and murkier, whittling down to nothingness. I couldn’t get checked out right away because nausea and vertigo hit hard the next morning, making it all but impossible to walk. So it took days before an ENT revealed that I was now half-deaf, for no detectable reason. (The most probable diagnosis was sudden sensorineural hearing loss.) Weeks of steroids and injections brought my right ear back to about half of its capacity, albeit with less ability to make out basic words. I was forced to spend thousands of dollars on a tiny battery-powered hearing aid, which I wore constantly until I misplaced it just a year later. To this day, I haven’t replaced it.

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Reader, you would not be the first to think I should’ve just done it long ago. But by the time I’d lost my hearing aid, a year of constant ENT trips, treatments, payments, and life adjustments had drained me (as did emotionally coming to terms with my new condition and what it would entail for the rest of my life). Even just the process for acquiring the pricey, flimsy, Bluetooth-connectable plastic toy that wrapped around behind my ear—so it would be hidden and I could avoid any stigma, they told me—made me despair. I had to book advance appointments at the faraway doctor’s office multiple times to sign various forms, undergo audiology tests, and pick up the hearing aid in person; I also had to cover the entire cost upfront, getting only a bit of insurance relief after mailing required papers all the way to El Paso. (This was for just one device, mind you; had I gotten a more sophisticated two-piece aid, I would have spent even more money.) After all that, I would have to return for more forms, tests, and in-person adjustments. By the time I’d misplaced the aid, I was mostly staying inside for our vaccineless COVID summer, so I figured the need for a new one wasn’t pressing. But even as public health conditions improved and my outdoor routines returned, I continued to rely on my (thankfully) still-strong left ear and adjusted accordingly, burned by those other experiences.

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It wasn’t until last week that I began seriously reconsidering that decision. On Aug. 16, the Biden administration finalized new rules that would allow for over-the-counter sales of hearing aids that, per Food and Drug Administration classifications, won’t require screening or prescription—and will be way more affordable than usual. Eligible devices wouldn’t cover the kind of steep hearing loss I’d initially sustained, but the ones I’d be able to get at a pharmacy, retailer, or online store would be of huge help for my current condition: impaired hearing on one side of my body that obscures my environs without fully obstructing them. A simple aid that could provide any bit of a boost would refill a missing part of my everyday perception. It’s sort of like being able to buy reading glasses without a prescription.

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I’m far from the only one who could benefit. According to the National Institutes of Health, about 30 million Americans above the age of 12 have some hearing loss in both their ears and could benefit from accessible devices. However, the FDA estimates, only 20 percent of the deaf and hard of hearing use them. (Hello to my fellow 80 percent.) As an ENT specialist told NPR, people shy away from the tech in large part because of the costs. An average hearing aid can cost anywhere between $4,000 to $5,000 because of existing regulatory and market factors: Purchase options are limited to licensed practitioners like audiologists, and about six companies make for 95 percent of the world’s hearing-aid supply. With the industry having mostly switched from cheaper analog models to phone-connectable digital devices—like the one I was prescribed—more expensive tech has become the default option, as well a source of major profits for corporations in the space.

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Plus, you can’t count on most insurance providers—or even Medicare—to help you out: Many classify hearing aids as “elective” items instead of essential health gear, disqualifying them from funding. Only five states mandate insurers to help cover hearing devices for both adults and children. This lack of coverage is both questionable and infuriating, considering that hearing loss can be a cause of depression and predictor of severe health conditions like dementia.

For such reasons, the movement for hearing-aid reform has been long in the making. In 2017, Sen. Elizabeth Warren introduced the Over-the-Counter Hearing Aid Act, requiring the FDA to classify some hearing aids for retail sale and issue new guidance appropriately. The bill was folded into the FDA Reauthorization Act of 2017; four years later, the agency finally proposed new over-the-counter rules, which were finalized this month. With any luck, we’ll start seeing hearing aids for sale through both physical and online retailers by mid-October. By the Biden administration’s calculations, increased product availability and market competition could lower product costs by $3,000, since the new rules require store-stocked aids to be sold at $600.

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This change has been widely praised as a historic shift. Prominent musician and playwright James Kennedy tweeted that “this decision will literally change my life.” Pennsylvania Senate candidate John Fetterman spoke to the hearing trouble he experienced following a stroke and called the new regulations “great news.” Even the Wall Street Journal’s conservative editorial board, no great cheerleader of the Biden administration, called this its “best move on regulation to date.”

There are still limits, of course. Those with deeper hearing loss will have to go through the usual system of prescription and purchase, without any substantial price relief or help with needed access. Disability historian Jaipreet Virdi—a longtime hearing-aid wearer with severe deafness—wrote in Wired that increased options could discourage medical-standard aid fitting and customization, which could lead to consumers not getting the actual help they need from their aids.

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Still, the new rules are a start, and a long-overdue one. They could go a long way to helping tens of millions of Americans finally get the hearing assistance they need, without the blockades of testing and heaping costs. More people wearing hearing aids could make the presence of the devices more common across the states, and help others with auditory trouble understand that they can and should get help. As for me: I’m ultimately grateful to my ENT for the treatment and care, but it’s difficult to imagine going through the whole technical process to replace my aid yet again. So I’m looking forward to doing some shopping come fall.

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.

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