Government Report 

I especially ask you tonight to join hands to pass the landmark bipartisan legislation proposed by Senators Kennedy and Jeffords, Roth, and Moynihan to allow people with disabilities to keep their health insurance when they go to work.

Not mentioned during his address, but announced a few days earlier, was his plan to not only give his full support to the Work Incentives Improvement Act, but also to propose tax breaks to help defer the costs of work-related expenses, such as personal assistance services and transportation. He also proposed increased grants to states to provide assistive technology to people with disabilities who need technology to help them work.

Another employment-related proposal that would have a direct impact on many workers with mental retardation would raise the minimum wage by $1 an hour over two years to $6.15. Other important proposals include tax credits for quality childcare and for stay-at-home parents; expanding the coverage of the Family and Medical Leave Act; and a five-year commitment to a skills program for dislocated workers.

Education

Students with mental retardation and other disabilities were not specifically mentioned in the president’s address. However, some of the proposals mentioned could have an impact on the implementation of the Individuals with Disabilities Education Act (IDEA). The president indicated that the emphasis this year will be on elementary and secondary education and making schools more accountable. A few of his proposals to improve education include continuing the goal of hiring 100,000 new teachers; ending social promotion and providing funds for summer and after-school programs for those not mastering the basics; making states and school districts accountable for the quality of their teachers; and making all states and school districts adopt and implement "sensible" discipline policies (see related article below).

President Clinton restated his support for consumer protections in managed care and urged Congress to "join together across party lines and pass a strong enforceable Patients’ Bill of Rights." The Democrats reintroduced their Patients’ Bill of Rights (S.6, H.R. 358) on the same day as the address. He also announced his intentions to step up efforts to treat and prevent mental illness. Finally, the president announced that the Department of Justice (DOJ) is preparing a litigation plan to take the tobacco companies to court. Any recovered funds would go to strengthen Medicare.

Civil Rights

In the area of civil rights, the president announced support for the passage of the Hate Crimes Prevention Act, stating that "discrimination or violence because of race or religion, ancestry or gender, disability or sexual orientation, is wrong and it ought to be illegal." At other public events, administration officials have indicated that the budget will include another increase for federal enforcement of civil rights laws.

Political Atmosphere

It will be interesting to see just how these initiatives fare since the vast majority of Clinton’s proposals must be enacted into law by the 106th Congress. The success or failure of many of these proposals will depend on the duration and final outcome of the Senate impeachment trial as well as whether the president and Congress can work together. Given the current highly partisan atmosphere, all legislative outcomes are difficult to predict.

In his State of the Union Address, the president began his speech with a plea for bipartisanship. Shaking hands with the new Speaker of the House, Dennis Hastert (R-Ill.), he referred to Hastert’s swearing-in remarks about "working together in a spirit of civility and bipartisanship." We can only hope that our government representatives can put aside their divisions and work together on many of the important current national issues that lie before them.  n

The National Bipartisan Commission on the Future of Medicare was created by Congress in the Balanced Budget Act (BBA) of 1997. Under the BBA, the commission is charged with examining the Medicare program and making recommendations to strengthen and improve it in time for the retirement of the "baby boomers." The commission is chaired by Sen. John Breaux (D-La.) and Rep. Bill Thomas (R-Calif.). It has 17 bipartisan members who have been appointed either by President Clinton or by House and Senate Republican and Democrat leaders. The commission’s report is due to Congress on March 1, 1999 and in order for any recommendation to make it into the report it must have the support of 11 of the 17 members. Some of the topics discussed by the commission include eligibility, benefits, program structure, financing and cost. (Details about the commission and their work can be found online at (http://medicare.commission.gov/)

The BBA of 1997 ensures solvency of the Medicare Part A Trust Fund for the next ten years. However, without reform it is predicted that the Trust Fund will go bankrupt in 2008. This is 24 years before the Social Security Trust Fund is supposed to run out of money. On top of this, 77 million "baby boomers" – born between 1946 and 1964 – could become eligible for Medicare in 2011.

Some of the general recommendations for reform are a cause for alarm. For example, Sen. Breaux, commission co-chair, recently suggested that the federal government — instead of continuing to directly pay the medical bills of the 39 million people now covered by Medicare -- help consumers buy coverage from HMOs and other kinds of insurance plans. This would place millions of people into a managed care system that has yet to prove that it can meet the health care needs of individuals with disabilities. Sen. Breaux’s proposal appears to have the support of Republican members of the commission and the insurance industry. However, Bruce Vladek, former administrator of the Health Care Financing Agency (HCFA) and a member of the commission, said that this would be the end of the Medicare entitlement.

Other general recommendations being discussed include raising the eligibility age from 65 to 67 and no longer using Medicare to subsidize the costs of training doctors.

CCD Concerns

From the very beginning, discussions of the commission have focused almost solely on Medicare and the elderly with very little attention paid to the importance of this program for the 4.7 million Medicare beneficiaries with disabilities under age 65. In fact, during commission discussions some comments were made that issues related to beneficiaries with disabilities were "welfare" issues and that people with disabilities did not belong in Medicare and should have their health care needs met some other way. For these reasons, a working group from the Consortium for Citizens with Disabilities (CCD) Health and Long Term Services and Supports Task Forces (including The Arc) weighed in with recommendations to the commission in Dec. 1998. commission members were urged to carefully consider these recommendations in developing the final report to Congress. The CCD recommendations are summarized below.

CCD recognizes that the Medicare program must be reformed in response to the changing demographics for the country. However, the consortium is concerned that some of the solutions to the future solvency of the Medicare program discussed so far could mean additional cost burdens and lost services for beneficiaries with disabilities under 65 who are disproportionately poor.

As the commission considers all solvency scenarios, CCD recommends that due consideration be given to the potential impact that any "financial solution" may have on the health and functional ability of current and future Medicare beneficiaries with disabilities. Approximately 85 percent of Medicare beneficiaries with disabilities have reported gross annual incomes of $25,000 or less and one-half have a reported gross annual income of under $10,000.

• The CCD believes that, since all beneficiaries within Medicare have met existing eligibility criteria in order to receive Part A and Part B services, all individuals who have earned the right to receive Medicare are entitled to the same types and levels of coverage and care. This is the Medicare program’s great policy strength.

• The CCD strongly opposes the bifurcation of the Medicare program. The separation of beneficiaries with disabilities under 65 from the Medicare beneficiaries over 65 would lead to lower health service benefit levels and diminished quality of care for persons with disabilities.

• The CCD strongly supports maintaining the existing structure of Medicare. However, we support a comprehensive benefit package that includes prescription drugs, adequate medical technology, and long term supports. Long term services and support issues must be addressed within the context of Medicare reform.

• The CCD supports Medicare reforms that would make the purchase of Medigap coverage unnecessary. Not only should Medicare provide a full range of comprehensive benefits, but currently most beneficiaries with disabilities below 65 are unable to acquire Medigap insurance due to discriminatory underwriting practices that Congress prohibited for Medicare beneficiaries over 65.

• The CCD strongly urges the commission to consider and support existing and future reforms that will strengthen work incentives for beneficiaries under 65 and not lessen the ability for beneficiaries to seek and retain employment.

• The CCD also urges the commission to pay particular attention to the needs of individuals who are "dually-eligible" for Medicare and Medicaid. We urge great caution in proposing reforms that would change eligibility criteria and health benefit levels for these individuals.

• The CCD believes that fiscal reform considerations must not preempt quality assurance protections for Medicare beneficiaries. Adequate quality assurance standards and performance measures for people with disabilities are still being developed for Medicaid and Medicare managed care regulations.

The Arc and the CCD will continue to work with the commission, Congress, and the administration on this important issue. n

The U.S. Supreme Court has agreed to review the Olmstead v. L.C. decision of the Eleventh Circuit Court of Appeals. The case is vitally important to people with mental retardation and other disabilities.

The Olmstead case stems from the claims of two women with mental retardation (L.C. and E.W.) who also have mental illness. The state of Georgia provided services to them in a state mental institution. The women claimed that Georgia unnecessarily institutionalized and segregated them in a mental hospital, rather than placing them in an appropriate, integrated community setting. They argued that these services violated their right to services in the most integrated setting under the Americans with Disabilities Act (ADA). The U.S. District Court ruled in favor of L.C. and E.W. The Circuit Court of Appeals affirmed the decision but also sent the case back to the District Court to determine whether providing integrated community services to these two women would "fundamentally alter" the services Georgia provides to people with mental disabilities.

Georgia then appealed to the Supreme Court which will make a decision by June. Led by Florida, 22 states and Guam supported Georgia’s position and submitted a brief urging the Supreme Court to review the case. The states originally on the brief were: Florida, Tennessee, Mississippi, Alabama, New Hampshire, Michigan, Nebraska, Montana, South Dakota, Texas, Pennsylvania, Delaware, Wyoming, Nevada, West Virginia, Maryland, Utah, Hawaii, Colorado, California, Louisiana, and South Carolina.

The good news is that due to the hard work of several state chapters of The Arc in coordination with other state advocacy organizations, four states have officially notified Florida that they will not join in the amicus brief before the Supreme Court. Those states are Maryland, Delaware, Utah and West Virginia. We have heard that Colorado has also removed itself from the brief; however, we do not have the documentation yet.

The L.C. v. Olmstead decision has been relied upon in numerous lawsuits designed to influence state provision of services to people with severe disabilities. It is one of the important cases in determining litigation strategy to move states to provide community-based services rather than institutional services. If the Supreme Court should overturn the Eleventh Circuit’s decision, it would be a devastating blow to the broad interpretation of the ADA and for people with disabilities seeking more integrated long-term services through Medicaid.

The Legal Advocacy and Human Rights Committee of The Arc will review and recommend action on an appropriate amicus ("friend of the court") brief and make a recommendation to President Brenda Doss regarding sign-on. Florida’s brief in support of Georgia is due Feb. 10. The amicus briefs in support of L.C. and E.W. are due in early March.n

President Clinton and the Republican Controlled Congress Jockey for Public’s Support for their Approaches to Education Reform

Education initiatives will be a dominant issue in Congress this year with the reauthorization of the Elementary and Secondary Education Act (ESEA). Both President Clinton and the Republican-controlled Congress are jockeying for the public’s support for their approaches to education reform. President Clinton announced his education initiatives in the State of the Union Address, and committees in the House and Senate are already holding hearings and mark-ups on some of their own proposals.

Although ESEA deals largely with issues other than those addressed by the Individuals with Disabilities Education Act (IDEA), several of the issues discussed to date may have implications for students with mental retardation and other disabilities. For example, the president has announced three proposals that have drawn considerable attention:

End Social Promotion. The president’s proposal would require states and school districts to end social promotion. This is the practice of promoting students from grade to grade regardless of whether they have mastered the appropriate material. The president’s proposal does not take into consideration the special education and related services needs of children with disabilities. Taken to the extreme, this proposal could severely undermine efforts to include students with mental retardation in regular education classrooms.

Qualified Teachers. This proposal would phase out the use of "emergency" teaching certificates that have the effect of putting unqualified teachers in classrooms. New teachers would also have to take performance examinations to demonstrate both subject-matter knowledge and teaching expertise. Administration examples used to show the need for these changes were of teachers unprepared to teach science and math. Not mentioned, unfortunately, is the equally common practice of placing unqualified teachers in special education classrooms.

Adopt Discipline Policies. The president wants state and local school districts to adopt "sensible" discipline policies. This proposal has raised considerable concern among disability advocates, including The Arc. Advocates do not want to see a return to the debates on cessation of educational services for students with disabilities or a reduction of due process protections in IDEA that have taken place during the last several years.

There are other issues that will arise during the reauthorization of ESEA – such as expanded school choice proposals, "returning control" to local schools, and "Ed Flex" (short-hand for educational flexibility proposals). All may have implications for students with mental retardation and other disabilities. Stay tuned for more details as the process develops.n

Notes:

A Jan. 14 article in the New England Journal of Medicine reports that – using 1996 data -- less than one-half of all Americans have their health insurance paid for by their employers. The article, "A Reappraisal of Private Employers’ Role in Providing Health Insurance," shows that private employers pay the health insurance costs for only 43 percent of Americans. In contrast, 34 percent of Americans are covered by government-paid insurance, including 22 million government workers and 69 million people with Medicare, Medicaid, Veterans or other government paid insurance. The government pays 47 percent of total health spending while private employers pay only 21 percent.

Free or low-cost health insurance is now available to millions of children through the State Children’s Health Insurance Program. In most states, uninsured children 18 and younger whose parents earn up to $32,900 a year (for a family of four) are eligible. However, the qualifications vary from state to state. The new Children’s Defense Fund web-site, "Sign Them Up!", provides detailed information on state programs, including specific eligibility requirements, program benefits and application and enrollment procedures for the 50 states and the District of Columbia. The site also offers outreach tools, including flyers (that can be downloaded) describing each states program. To view this new web-site go to http://www.childrensdefense.org/signup.

The Jan. 26 Federal Register includes a notice of the availability of funds for Welfare-to-Work Competitive Grants. These grants, funded through the U.S. Department of Labor Employment and Training Administration, are to help states and local communities to assist hard-to-employ people who have been on welfare to find jobs. In this announcement, the DOL is putting a high priority on funding applications targeted to five specific populations who face particular challenges in moving from welfare to work. This includes, among others, people with disabilities. Applications targeting these individuals may be eligible for bonus points. Eligible applicants include Private Industry Councils, community development corporations, disability community organizations, and other qualified organizations. The application deadline is April 30. For more information, contact Mamie Williams, Grant Management Specialist, Division of Federal Assistance. No phone number is provided but the fax number is 202-219-8739 and the e-mail address is disgu-sga@doleta.gov. Any questions should refer to the SGA number DFA 99-003. The funding announcement is also on the web at http://www.doleta.gov/.

On Jan. 26, the General Accounting Office (GAO), released its report, Lead Poisoning: Federal Health Care Programs are not Effectively Reaching at-risk Children, (GAO/HEHS-99-18). The report states that there are hundreds of thousands of children with very high levels of lead in their blood who are not being screened by federal health programs. According to the report, by law, all young children who are enrolled in Medicaid and a number of other health programs are required to be tested for lead. However, only 18 percent of these children are getting tested. The result of exposure to lead – even in small amounts – can lead to disabilities in children.

Register for the 1999 Governmental Affairs Seminar (March 14-16) online! Click online registrations on The Arc’s home page (http://thearc.org/). Registration packets were also included in the Feb. issue of The Arc Now.n

Government Report Index – 1998

This is an index of Government Report articles and "special features" published in 1998. It is designed to provide readers with a helpful guide to Congressional and Administration actions, as well as actions of The Arc, during the Second Session of the 105^th Congress. This Index should also provide you with useful background as we begin the First Session of the 106^th Congress.

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