1) What’s Happening in the Nation’s Capital?
House of Representatives Makes History with Passage of Healthcare Bill
2) National News
Back to the Senate!
Federal Olmstead Enforcement by CMS - A New Day?
Poverty and Disability Greatly Correlated, New Study Shows
Republicans Offer Alternate Plan as Amendment
3) State News
Oregon Becomes First State to Eliminate ICFs/MR
4) Announcements and Additional Resources
United We Ride National Dialogue Now Live!
VA Extends “Agent Orange” Benefits to More Veterans
House of Representatives Makes History with Passage of Healthcare Bill
On Saturday night, at about 11:15pm Eastern, the House of Representatives passed the Affordable Healthcare for America Act of 2009, H.R. 3962. The vote was close, with a final tally of 220-215, mostly along party lines. There were 39 Democrats who voted against the bill and one Republican who voted for it. Never before has legislation to overhaul the nation’s healthcare system passed either chamber in Congress. This was monumental, but only the first of the epic steps left in the process.
NCIL strongly encourages members to see how your member of Congress voted, then contact them. Thank those who voted for the bill, and express disappointment with those who voted against it. This is as important as calling to urge them to vote a certain way because this will not be the last vote! A final bill will have to be compromised and then voted on by both Chambers.
NCIL Policy Analyst Jason Beloungy attended the floor debate in the House. Several hundred citizens were trying to gain access to the debate and many were ardent opponents of the bill. Members of Congress are being flooded with the message that Americans don’t support reform by passionate and vocal minority. We need everyone who supports reform and independence for people with disabilities to call their Senators and Representatives, or we may lose the opportunity.
During the debate, NCIL’s two biggest priorities in HR 3962 were addressed. Congressman Frank Pallone took the podium to speak in support of the CLASS Act provision. Shortly after, Congressman Henry Waxman addressed his colleagues on the need to remove the barriers to long-term care in the community for Americans on Medicaid (the aim of the Community First Choice Option). NCIL applauds Chairmen Pallone and Waxman for standing up for the rights of people with disabilities, who should have a choice to live in the community and have options to make that possible regardless of income or work status. They said:
Mr. Pallone: The bill we are debating today includes the CLASS Act, a bill I sponsored, along with Representative Dingell, which would encourage individuals to plan ahead for future long-term care needs. But there are other things we can do to help increase the availability of home and community-based services. The Empowered at Home Act, H.R. 2688, which I sponsored with Representative DeGette, helps encourage States to improve and increase access to home and community-based services under their Medicaid programs. While we were not able to include these other provisions from the Empowered at Home Act in H.R. 3962, I hope that we can consider their inclusion in the final health reform bill that emerges from the conference with our Senate colleagues.
Mr. Waxman: I want to thank the gentleman from New Jersey for his leadership on the bill before us today and for his tireless efforts on behalf of low-income Americans who need long-term care. I support the elimination of barriers to the provision of home and community-based services under Medicaid, a result that the gentleman's Empowered at Home Act would achieve. …I will continue to work with you and other Members to enact legislation that gives State Medicaid programs a robust option for offering low-income Americans the choice of receiving long-term care services in the community rather than in a nursing home.
NCIL congratulates the Leadership of the House on their ability to pass this measure, as it contains several provisions that will help introduce fairness and equality to the long-term care and healthcare systems.
If you have questions about HR 3962, about the reform process, or about contacting you members of Congress, contact NCIL Policy Analyst Jason Beloungy at 202-207-0334 (toll-free 1-877-525-3400), ext. 1008 or at jason@ncil.org.
Back to the Senate!
Pressure is mounting on the Leadership to pass a bill by the end of the year, but skepticism for is growing because efforts in the Senate have been delayed at each critical point. The skepticism is an acknowledgment that with only two months left in the year, Democrats are still a long way from sending a bill to the president’s desk. The battle in the Senate is the next phase, and it will drag on in the coming weeks.
The Senate Majority Leader, Harry Reid, is still working on two barriers to reform in the Senate. One barrier is the cost-estimate or “score” from the Congressional Budget Office (CBO). Because the Majority Leader sent multiple proposals to be scored, it is taking longer than expected. The earliest a score will be released is by the end of this week, possibly pushing debate until the week of Thanksgiving. This delay will make it almost impossible for a final bill to be signed by the President before the end of the year.
The second barrier is garnering enough support to allow the legislation to go to a vote. Since Reid indicated that the bill includes the “Public Option”, some moderate Democrats and an Independent Senator have said they won’t support it and may even block the bill from a vote. Senator Reid and others in the Leadership need to convince their colleagues of the merits of the bill.
Stay tuned for more information about the Senate’s legislation and for NCIL Action Alerts. These next few alerts will be some of the most important and full action by our membership will send a strong signal to Congress about the need for quality reform now!
Federal Olmstead Enforcement by CMS - A New Day?
Steve Gold Information Bulletin # 295
Ten years after the Supreme Court issued the Olmstead decision holding that unnecessary institutionalization violated the ADA and nine years after CMS wrote its ADA/Olmstead "State Medicaid Director" letters pursuant to this decision, CMS finally put some bite behind Olmstead.
On 10/30/09, CMS wrote the Missouri Department of Social Services that Missouri's MA home health services, which required people to be "homebound," was "not in compliance with Federal requirements." CMS pointed out that the Supreme Court in Olmstead, "reinforced the ADA by affirming the right of individuals with disabilities to live in their communities." CMS provided Missouri 30 days to change its policy or CMS could "proceed with compliance proceedings" which could "result in withholding Federal funding."
Just think, CMS took a step which reflects that civil rights of people with disabilities are real. Sure it's taken ten years, but maybe, just maybe, this CMS letter signals a new day. While confronting the "homebound" issue is obviously very important, the significance of what CMS did goes far beyond this one issue.
Does your state have a waiting list for people in nursing homes to receive sufficient MA services in the community so they will not need to be in an institution? If yes, then how does your waiting list "affirm the right of individuals with disabilities to live in their communities"? Waiting lists ensure just the opposite.
Does your state offer people who are at imminent risk of going into a nursing home meaningful services BEFORE they go into the institution? If no, then the failure to provide real services ensures that people will have to go into nursing homes and will not be able to live in their communities.
Wouldn't it be interesting if CMS really enforced Olmstead and told states that 10 years waiting for full implementation of Olmstead is far too long? Wouldn't it be a great CMS step to tell states that 10 years is more than enough time. Many states continue to dither because they do not believe CMS will do anything. Despite the Supreme Court's decision, States continue to genuflect to the nursing home industry and perpetuate unnecessary institutionalization in violation of Olmstead, in large part because CMS has shown no will to enforce the ADA. Will CMS take on these States?
It's not too far-fetched to believe CMS might. After all, CMS would not permit States to deny MA services based on race, religion or gender in violation of other federal civil rights statutes. Maybe CMS has begun to recognize disability and the ADA as a real federal civil rights issue.
And while we're thinking about federal enforcement of the ADA and Olmstead, what about the U.S. Department of Justice? Without affirmative, aggressive DOJ enforcement, schools would have remained racially segregated, voting provisions would have continued to be racially tinged, and women sports (Title IX) would have never been implemented.
Yes, with race and gender, the U.S. Department of Justice showed the country and many States that federal enforcement was real. It's truly thanks to DOJ that these abuses were stopped.
What about DOJ showing States -- 19 years after Congress enacted the ADA finding segregation (in 1990) existed and 10 years after the Supreme Court ruled in Olmstead E28093 that DOJ will affirmatively and aggressively enforce the ADA and will end the unnecessary institutionalization of people with disabilities?
Poverty and Disability Greatly Correlated, New Study Shows
Source: Chicago Tribune, by Mike Ervin
Hard economic times are even harder when you have a disability. But poverty and disability don't have to be synonymous if we design our policies well. A new report from the Center for Economic and Policy Research (a Washington-based think tank) titled "Half in Ten" states that almost 50 percent of working-age adults who experience poverty for at least a 12-month period have one or more disabilities.
People with disabilities, the report says, account for a larger share of those experiencing poverty than people in all other minority, ethnic and racial groups combined and are even a larger group than single parents. The extra costs associated with living with a disability such as purchasing expensive equipment like wheelchairs and catheters or obtaining specialized medical attention keep many disabled people and their families in poverty, the report notes.
The report also astutely observes that direct care workers who assist people with disabilities in their homes and communities are often themselves in poverty. The median income for the 3 million direct care workers in the United States is only $17,000 a year, the report says.
Fortunately, there are several steps we can take to ensure that disability doesn't spell poverty.
The first step is universal health care. The report stresses "the fundamental importance of health care reform, especially the provision of universal coverage, to anti-poverty efforts." The lack of good health insurance, the report says, "is one of the most significant drivers of income poverty and severe disadvantage." Another important step is for the United States to adopt "the kinds of paid-sick-day and paid-sick-leave policies that are already in place in all other similarly wealthy nations." At least 40 percent of private sector workers in the United States have no paid sick days or leave, the report says.
Third, we should ease the ridiculously harsh restrictions on assets and earnings imposed on those receiving Social Security Disability Income. The current Social Security policy basically requires you to impoverish yourself before you can get disability aid from the government.
And, fourth, we should pay a decent wage to the health care providers who do such a superb job in tending to the needs of the disabled.
It's clear that the current economic hardship is being made much worse for many people than it needs to be due to the disregard politicians and policymakers have for the well-being of Americans with disabilities and those who work in providing them with assistance. It's time for that to change.
Republicans Offer Alternate Plan as Amendment
Early last week, Republicans in the House released an alternate version of healthcare reform legislation and offered as an amendment to HR 3962 on the House floor on Saturday. House leadership restricted each party to one amendment.
The amendment, which was estimated by the Congressional Budget Office (CBO) to cost about $61 Billion over 10 years, takes a different approach and has different priorities for reform. The focus of the Republican legislation is to:
- lower healthcare costs,
- create universal access programs,
- reduce “junk lawsuits”,
- encourage insurance pools to small businesses,
- enhance health savings accounts, and
- eliminate the insurance industry practice of rescission.
NCIL applauds provisions that work to eliminate the practice of rescission, the provision to enhance state-run high risk insurance pools and reinsurance programs, elimination of some requirements for guaranteed availability of insurance for people with pre-existing conditions, and exclusion of annual or lifetime caps on spending in health insurance coverage or plans.
However, the Republican proposal has no provisions to address the priorities laid out by NCIL’s membership. Specifically, the Republican alternative does not include:
- the Community First Choice Option,
- the CLASS Act,
- accessibility standards for medical and diagnostic equipment,
- mental health and substance abuse parity language,
- enhancement of benefits for insurance programs to include Durable Medical Equipment, or
- language that goes far enough to end the discrimination against people with pre-existing conditions.
The CBO estimate of $61 Billion over 10 years is far less than the roughly $1 Trillion price of the Democratic plan because of the glaring differences. The Democratic plan passed on Saturday aims to cover the vast majority of legal citizens, while the Republican plan does not. The CBO estimated that after 10 years, 17 percent of legal, non-elderly residents won't have health-care insurance. The Republican alternative would have helped 3 million people secure coverage, which is offset by the growth in the population. The Democratic plan would cover 36 million more people and cut the uninsured population to 4 percent. Additionally, the aim of the Republican plan is to save money, but their plan only reduces the national deficit by $68 billion over the next 10 years, while the Democratic plan would reduce it by $104 billion.
Ultimately, the Republican Amendment failed a vote on the floor of the House on Saturday, and has no chance of passing the House as a stand-alone bill.
Oregon Becomes First State to Eliminate ICFs/MR
As of the close of business November 5, 2009, Oregon became the first state in the nation to have no “Intermediate Care Facilities for the Mentally Retarded” (ICFs/MR) and no citizens residing in ICFs/MR in other states. This includes public and community facilities. Oregon is now operating 100% under the community waiver.
Before yesterday, the only other state operating with no public or private ICFs/MR was Alaska, which has about 10 people in out-of-state ICFs/MR.
United We Ride National Dialogue Now Live!
NOVEMBER 2-13, 2009
From United We Ride: It's here! The United We Ride National Dialogue begins today and we're looking forward to having you join us at www.uwrdialogue.org.
Do you have a suggestion or an idea about how to increase access to affordable and reliable transportation services for people with disabilities, older adults, and people with limited incomes? Please join the Dialogue now at www.uwrdialogue.org to share your best ideas! Over the next 12 days, you have the opportunity to participate in an online dialogue with other national, state and local stakeholders. Stakeholders like you can provide critical input to the Federal Interagency Coordinating Council on Access and Mobility (CCAM) and help the best ideas 'rise to the top' during the dialogue. Just click the link at the bottom to register for this free on-line dialogue! It is important that this dialogue be as inclusive as possible, so please spread the word.
For more information about this exciting new collaborative opportunity, please visit: www.UWRdialogue.org.
VA Extends “Agent Orange” Benefits to More Veterans
Source: Department of Veterans Affairs
Relying on an independent study by the Institute of Medicine (IOM), Secretary of Veterans Affairs Eric K. Shinseki decided to establish a service-connection for Vietnam Veterans with three specific illnesses based on the latest evidence of an association with the herbicides referred to Agent Orange. The illnesses affected by the recent decision are B cell leukemias, such as hairy cell leukemia; Parkinson’s disease; and ischemic heart disease.
Used in Vietnam to defoliate trees and remove concealment for the enemy, Agent Orange left a legacy of disability that continues to the present. Between January 1965 and April 1970, an estimated 2.6 million military personnel who served in Vietnam were potentially exposed to sprayed Agent Orange.
In practical terms, Veterans who served in Vietnam during the war and who have a “presumed” illness don’t have to prove an association between their illnesses and their military service. This “presumption” simplifies and speeds up the application process for benefits.
The Secretary’s decision brings to 15 the number of presumed illnesses recognized by the Department of Veterans Affairs (VA). “We must do better reviews of illnesses that may be connected to service, and we will,” Shinseki added. “Veterans who endure health problems deserve timely decisions based on solid evidence.” See other illnesses previously recognized under VA’s “presumption” rule as being caused by exposure to herbicides during the Vietnam War.
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November 9, 2009