Hearing aids cost an average of $5000. Biden's plan to make them affordable doesn't go far enough.

• President Biden's recent executive order aims to address, among other things, the exorbitant costs of hearing aids.
• Hearing aids cost an average of $5,000 and are rarely covered by insurance.
• Only 14% of the 48 million Americans with hearing loss can afford hearing aids.
• Over-the-counter hearing aids are not meant for children or those with severe or profound hearing loss.
• Erin Marsh is a writer and yoga teacher from the Midwest.

President Biden issued an executive order last week to promote competition in the American economy. The order aims to address, among other things, the exorbitant costs of hearing aids.

My family knows the sky-high prices of hearing devices all too well. Our 5-year-old daughter, Camille, and I are both hard of hearing with a rare reverse-slope hearing loss, or low-frequency loss. We paid over $3,000 for Camille's hearing aids, none of which was covered by insurance as hearing aids are considered cosmetic and elective.

We were able to secure a grant for her FM receiver, which allows her to participate in sports and better understand teachers, and that was another $3,000. Her hearing tests - which are required annually by the audiologist to adjust her hearing aids - cost just under $800, with only a portion covered by our insurance. My own hearing aids would have been nearly $5,000 through an audiologist, but I opted for the cheaper route: Costco hearing aids for roughly $2,000. Our hearing aids must be replaced approximately every 5 years for the duration of our lives.

The Fact Sheet issued by the White House asserts the executive order will "save Americans with hearing loss thousands of dollars by allowing hearing aids to be sold over the counter at drug stores."

However, the Obama administration attempted to make hearing aids more affordable and as easy to purchase as reading glasses. Then the Over-the-Counter Hearing Aid Act of 2017 promised to effectively lower costs, yet prices remained steady. The White House explains this was because "the Trump Administration Food and Drug Administration failed to issue the necessary rules that would actually allow hearing aids to be sold over the counter, leaving millions of Americans without low-cost options." The hope is the Biden administration can learn from past errors to enact lasting change this time around.

I have been hard of hearing likely since birth, yet I am only on my second pair of hearing aids due to cost, and we are a middle class family. I am not alone: Only 14% of approximately 48 million Americans with hearing loss can afford the hefty price tag. On average, hearing aids cost $5,000 a pair and are seldom covered by insurance.

My hearing loss went undetected most of my life despite the fact that it is significant. Low-frequency losses go undiagnosed largely for two reasons: speech is rarely affected, and basic hearing tests check for high-frequency loss as it is the most common. Eventually I failed a school hearing test in elementary school, but my results fell through the cracks, and my mother wasn't alerted of the results until I reached junior high. In the 90s, I was not offered accommodations or placed on an Individualized Education Program (IEP), and my single mother couldn't afford thousands of dollars on hearing aids. I spent my educational years adapting the best I could.

My first professional job after graduating college was teaching high school English in NYC, and I certainly couldn't afford hearing aids living in one of the most expensive cities in the world on a teacher's salary. It wasn't until I settled down in Ohio and heard about financial help through the Ohio Bureau of Vocational Rehabilitation that I received my first pair in my late 20s. However, I was explicitly told that the program was "one and done." I needed to pay for future hearing aids on my own.

By the time that pair stopped working, I had become a mother and transitioned to a career in writing. I couldn't justify spending thousands of dollars (that we didn't have) on hearing aids as a writer. I reasoned that I'd spent most of my life without hearing aids and was used to it, so I could continue to make do.

But then my daughter was born. She passed the newborn hearing test and her preschool auditory exam, but again, they only test for high-frequency loss. Despite the passing results, I noticed the tell-tale signs of hearing loss - inability to understand unless facing someone, continuous glances at our mouths for clarification, blank stares when strangers asked questions - and I took her to an audiologist for a comprehensive audiogram (hearing test) where they discovered my identical moderately severe reverse-slope loss.

As is common, insurance didn't cover a dime of her hearing aids. We applied for assistance through a state hearing program but were denied. We opted for the cheapest pair available for children through our audiologist - $3,200 - and are still paying them off almost two years later.

While President Biden's plan could potentially help millions of Americans, it omits many. Over-the-counter (OTC) hearing aids are not meant for children, nor should they be. It takes a pediatric audiologist to appropriately fit and adjust hearing aids for a child. Furthermore, OTC aids would be available to those with mild-to-moderate hearing loss - not those with severe or profound loss. Whether or not they could work for rare hearing losses, such as cookie bite or reverse slope, is unclear.

The issue with providing hearing aids over-the-counter is that each hearing loss is unique; it truly requires a professional to appropriately fit hearing aids. In my experience, audiologists won't/can't adjust hearing aids bought elsewhere, leaving OTC hearing aid adjustments up to the individual. It would be like buying reader glasses at the pharmacy. Some may benefit, but most who need prescription glasses do not.

If the Biden administration could mandate that insurance companies cover a majority of hearing aid expenses - after all, glasses and braces are covered - then all hearing losses for all ages would be included. Some insurance companies do cover a portion of the expense, but it's usually minimal, such as $600 of the $5,000. If the Biden administration could effectively lower the cost of hearing aids by increasing competition and also demand insurance coverage, then all might benefit. In other wealthy nations, hearing aids are covered - why not here? Right now the Biden plan is a first step toward improving access for the deaf/hard of hearing community but is not a comprehensive solution.

Yet any movement to help with the cost of hearing aids is appreciated, and perhaps the most promising part of this executive order is the challenge to monopolies. The four largest hearing aid companies control 84% of the market, which means they can set whatever astronomical prices they wish. Deregulation could jeopardize their profits, and Starkey Hearing Technologies responded by increasing their political contributions, spending more than big-name medtech firms.

In a world where a $300 watch contains the technological advances of a phone, how could hearing aids possibly cost an average of $5,000? Or what about an audiogram, which is a series of beeps and recordings dictated and transcribed by a computer, for which hospitals unapologetically charge $800? In contrast, an identical hearing test at Costco is free.

President Biden's executive order is a first step in making the world more accessible and inclusive for all of us who are deaf and hard of hearing. With increased competition and wider availability, hearing aid prices will hopefully plummet. Perhaps one day, hearing aids will be as commonplace and affordable as a pair of glasses. In the meantime, we will need to continue to advocate for basic access to sounds that most people take for granted.