Action Alert: The Transformation To Competitive Employment Act

This Action Alert comes from the Center for Public Representation, via the New York Association on Independent Living (NYAIL) ...

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#WorkWithUs by joining the July 9th national call-in day to support the Transformation to Competitive Employment Act

Tell your members of Congress to support competitive integrated employment and end the payment of subminimum wages to people with disabilities by supporting the Transformation to Competitive Employment Act (TCEA).  The TCEA H.R. 873 in the House and S. 260 in the Senate) is a bi-partisan bill that will expand opportunities for competitive integrated employment – community jobs where people with disabilities work alongside co-workers without disabilities and are paid the same wages – and phase out the outdated and discriminatory payment of subminimum wages to people with disabilities currently allowed under Section 14(c) of the Fair Labor Standards Act.

The TCEA will address barriers to employment for people with disabilities by providing $300 million in capacity-building grants and technical assistance to expand opportunities for competitive integrated employment while phasing out subminimum wages over six years. The bill will help states and 14(c) certificate holders (businesses that pay workers with disabilities subminimum wages) transform their business models to more integrated and innovative approaches to disability employment.

Ask your members of Congress to support and co-sponsor the TCEA during the national call-in day on Tuesday, July 9th. Please visit the TCEA National Call-In Day Facebook Event or this page to learn more about the TCEA.

#WorkWithUs to get Congress to expand opportunities for competitive integrated employment and end subminimum wages!

How to Reach Your Members of Congress:

1 Call the Capitol Switchboard at (202) 224-3121 (voice) or (202) 224-3091(tty) and ask to be connected to your Representatives and Senators.

2 Repeat. You can use this easy tool to find your members of Congress.

Easy Call Script:

Hello, this is [Name]. I’m a resident of [Town, State].

I am your constituent. Please support and co-sponsor the Transformation to Competitive Employment Act (H.R. 873/S. 260). This bill will help address barriers to employment of people with disabilities. It provides funding and technical assistance to states and providers to expand capacity for competitive integrated employment while carefully phasing out over six years the ability of businesses to pay people with disabilities below the minimum wage – often pennies on the dollar — under Section 14(c) of the Fair Labor Standards Act. The bill will help businesses using 14(c) certificates transform into competitive, integrated workplaces where people with disabilities work alongside people without disabilities and get paid equal pay for equal work. Just like everyone else, people with disabilities want to work, live independently and be self-sufficient. Support and co-sponsor the Transformation to Competitive Employment Act to improve employment opportunities for people with disabilities!

Thank you for taking my call!

[IF YOU ARE LEAVING A VOICEMAIL:

Please leave your full street address and zip code to ensure your call is tallied]

[OPTIONAL ADD ON]

Personal stories are the most effective form of advocacy. Talk about why the Transformation to Competitive Employment Act is important for you or someone you know and love.

Clinton County Transportation Meetings

The following is a notice from the Clinton County Planning Department about upcoming public meetings and hearings on proposed changes in Clinton County Public Transit (CCPT):

Thursday, June 27, 1-3 PM
Public Information Meeting
First floor meeting room, Room 103, Clinton County Government Center
137 Margaret Street, Plattsburgh

Wednesday, July 10, 7 PM
Clinton County Legislature Public Hearing
Legislative Meeting Room, Clinton County Government Center
137 Margaret Street, Plattsburgh

Clinton County Public Transit (CCPT) is considering bus route changes for implementation on August 12th, 2019. The proposed changes include elimination of the West End bus route and elimination of the 8:53 pm run of the CCC Seasonal bus route, among other changes.

CCPT will be hosting a public information meeting on Thursday June 27th from 1:00 pm to 3:00 pm in the first floor meeting room, Room 103, of the Clinton County Government Center; 137 Margaret Street; Plattsburgh, NY 12901 to discuss the proposed service changes and receive public input. This meeting is open to the public and all are welcome and encouraged to attend and participate.

Those who are unable to attend in person but would like to attend by way of conference call can call 1-712-451-0011 and use access code: 853408

If you cannot attend this meeting but you would like to give input, provide written comments, or ask questions; please contact:

James Bosley, Planning Technician
Clinton County Planning Department
135 Margaret Street Suite 124
Plattsburgh, NY 12901
518-565-4713
james.bosley@clintoncountygov.com

In addition to this public meeting, there will be a public hearing at the session of the Clinton County Legislature when bus route changes are voted on. It is anticipated that the bus route changes being proposed will go before the Clinton County Legislature at their 7:00 pm session on Wednesday July 10th and the public hearing will be at the beginning of that meeting.

Clinton County does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services. In compliance with the Americans with Disabilities Act, special accommodations, within reason and upon request at least forty-eight hours in advance of the public meeting, will be provided to persons with disabilities. Please contact James Bosley, Planning Technician, at 518-565-4713 or by email at James.Bosley@clintoncountygov.com to request a special accommodation for the meeting.

For anyone who would like travel training to better understand the CCPT routes/services and how to use them, please contact James Bosley (contact information is above) and arrangements will be made for travel training.

Action Alert: Money Follows The Person

The following advocacy alert comes from the Center for Public Representation:

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Call your Senators now to fund the MPF Program

Last night the House passed H.R. 3253, the Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act.  This bill funds the Money Follows the Person program through the Fiscal Year 2023. It also extends the HCBS spousal impoverishment protections through March 31, 2024. Thank you for your hard work in advocating to #FundMFP.

We now need the Senate to act! Join our national call-in day and ask your Senators to #FundMFP.  We have a Facebook event with talking points to make it easy for you to call and spread the word or instructions are below. Together we can get Congress to extend this critical program that has helped more than 80,000 people move back to the community!

To Call your Senators:

1. Call the Capitol Switchboard at (202) 224-3121 (Voice) or (202) 224-3091 (TTY) and ask to be connected to your senators. 

2. Repeat. You can use this easy tool to find your members of Congress.

Easy Call Script:

Hello, this is [Name]. I’m a resident of [Town, State].

I am calling to ask Senator [INSERT NAME] to fund the Money Follow the Person (MFP) program.

MFP has enabled over 90,000 older adults and people with disabilities living in institutions to transition back to their communities. MFP is fiscally responsible: it has improved the quality of life for thousands of individuals while saving states money. Congress passed stop-gap funding for the program in January 2019, but those funds will run out in September 2019.

I am asking [Senator’s Name] to cosponsor and support the EMPOWER Care Act S. 548 and H.R. 3253 passed by the House and reauthorize Money Follows the Person Program.

Thank you for taking my call!

[IF LEAVING A VOICEMAIL: please leave your full street address and zip code to ensure your call is tallied]

[Optional Add On]

Personal stories are the most effective form of advocacy. Talk about why Money Follows the Person is important for you or someone you know and love.

==========

Our U.S. Senators from New York are:

Sen. Kirsten Gillibrand
@SenGillibrand

Washington DC Office
478 Russell
Washington, DC 20510
Tel. (202) 224-4451
Fax (202) 228-0282

North Country Office
PO Box 273
Lowville, NY 13367
Tel. (315) 376-6118
Fax (315) 376-6118

Sen. Chuck Schumer
@SenSchumer

Washington DC Office
322 Hart Senate Office Building
Washington, DC 20510
Phone: (202) 224-6542
Fax:  (202) 228-3027

Albany Office
Leo O'Brien Building, Room 420
Albany, NY 12207
Phone: (518) 431-4070
Fax:  (518) 431-4076

The 2019 New York State Disability Priority Agenda

Staff from the North Country Center for Independence are in Albany today to meet with legislators and advocate for better disability-related policies in New York State. As a member center in the New York Association on Independent Living, (NYAIL), NCCI will be focusing our broader advocacy 2019 on the issues outlined on the pages linked below:

NYAIL 2019 Legislative Disability Priority Agenda
Policy changes we want to see in New York State.

NYAIL 2019 Budget Disability Priority Agenda
New York State budget steps we want to see.

The following documents provide additional background on the current state policies and trends that determine our goals for 2019:

NYAIL Legislative Report Card 2019
An assessment of past promises and current New York State disability policy.

NYAIL Budget Report Card 2019
An analysis of how the current New York State budget addresses disability issues.

NYAIL’s 2019 Budget Priorities Letter to Governor Cuomo
Our message to Governor Cuomo for 2019.

Action Alert: Last Chance to Stop the Dangerous Tax Cuts and Jobs Act

Update on the original Action Alert below, from the Consortium for Citizens with Disabilities: As we emailed over the weekend, it is critical that we keep up the advocacy against the tax bill with the House. The report that we got from the Hill this morning is that targets in the House were pounded with opposition to the bill over the weekend.  Keep it up! Re timing of the bill, we know that a vote in the House is scheduled for 6 pm today.  While the intel we are getting is that the vote is likely going to be to set up a conference, it still is possible that the House could just vote to accept the Senate bill.  And the timing of a conference is complicated by the other work that Congress needs to do this week to keep the government open.  We'll be sending another update late today. In case it is helpful to your advocacy, here is the CCD fact sheet on the worst impacts of the tax bill on people with disabilities; here is a link to call, email, and with talking points; and here is a recent alert from AAPD with lots of resources. CCD Fiscal Policy Task Force ========== This Action Alert comes from the American Association of People with Disabilities: Early Saturday morning (around 2am Eastern Time), the Senate passed their version of the Tax Cuts and Jobs Act. This vote in the middle of the night left little to no time for other Members of Congress and the general public to review the content of the bill. Since the House of Representatives passed their version of the Tax Cuts and Jobs Act (H.R. 1) in mid-November, the House and Senate must now reconcile their versions of the bill. This is expected to happen in Conference Committee starting today. It is also possible that the House will pass the Senate’s version of the bill as is. Either way, the Tax Cuts and Jobs Act is very close to reaching President Trump’s desk and becoming law. NOW is the time to call your Representative and tell them to OPPOSE this dangerous bill! Key Provisions for People with Disabilities in the House and Senate Tax Bills – Consortium for Citizens with Disabilities The Top 5 Reasons the Tax Cuts and Jobs Act is Bad for People with Disabilities – Consortium for Citizens with Disabilities The Senate tax bill is extremely dangerous to the well-being of people with disabilities. Tax cuts open the door for cuts to Medicaid, Medicare, Supplemental Security Income, and other services that benefit people with disabilities. While neither the House nor Senate tax bill includes direct cuts to these services, cuts are expected to follow to offset the $1.5 trillion added to the deficit due to providing large tax cuts to the wealthiest Americans. Medicaid and other disability services were the target of intense cuts over the summer through the various Affordable Care Act (ACA) repeal bills proposed in the House and Senate. There is no doubt that these same services remain on the chopping block to help pay for the proposed tax cuts. The Senate bill eliminates the Affordable Care Act (ACA) individual mandate. The individual mandate helps make health insurance affordable. The Congressional Budget Office (CBO) estimates that 13 million people would lose access to affordable coverage by 2027 if the individual mandate were eliminated. Furthermore, insurance premiums would rise by 10%, which amounts to an increase of hundreds of dollars per year for nearly 7 million middle-income Americans and by over $1,000 per year for seniors, according to the Center on Budget and Policy Priorities (CBPP). The Senate bill benefits the wealthiest Americans while the poorest would be worse off. The Congressional Budget Office (CBO) released a report which found that Americans earning less than $100,000 a year would, ultimately, not benefit from the proposed tax cuts. According to a Washington Post analysis of the CBO report, “By 2019, Americans earning less than $30,000 a year would be worse off under the Senate bill, CBO found. By 2021, Americans earning $40,000 or less would be net losers, and by 2027, most people earning less than $75,000 a year would be worse off. On the flip side, millionaires and those earning $100,000 to $500,000 would be big beneficiaries, according to the CBO’s calculations.” The House bill is also damaging as it proposes to eliminate several tax deductions and credits that benefit people with disabilities. These include: The Medical Expense Deduction: This tax deduction allows people to deduct large, unreimbursed medical and dental expenses that exceed 10% of their income. Approximately 8.8 million people utilize this deduction, 70% of which have an income at $70,000 or lower. Most filings are around $10,000 by people with high healthcare costs, which largely includes people with disabilities, chronic health conditions, and other medical conditions. People are allowed to deduct expenses for a variety of expenses including treatments, surgeries, medications, and medical travel. The Disabled Access Credit and Barrier Removal Tax Deduction: Businesses that accommodate people with disabilities may qualify for tax credits and deductions including the Disabled Access Credit and the Barrier Removal Tax Deduction. This credit and deduction incentivizes small businesses to make their businesses accessible for disabled people. Small businesses can claim a 50% credit per year for expenditures between $250 and $10,250 that increase access and compliance with the Americans with Disabilities Act (ADA). The Work Opportunity Tax Credit: This federal tax credit is available to employers for hiring individuals from certain target groups (including disabled people who receive services from Vocational Rehabilitation, SSI recipients, returning citizens, veterans, and long-term unemployment compensation recipients) who have consistently faced significant barriers to employment. The current tax credit for hiring a person with a disability can be as high as $2,400 for a business. The final version of the Tax Cuts and Jobs Act could contain any of these harmful provisions from the Senate and House bills. While neither tax bill includes direct cuts to Medicaid or other disability services, these cuts are expected to follow to offset the roughly $1.5 trillion added to the deficit due to providing large tax cuts to the wealthiest Americans. Medicaid and other disability services were the target of intense cuts over the summer through the various Affordable Care Act (ACA) repeal bills proposed in the House and Senate. There is no doubt that these same services remain on the chopping block to help pay for the proposed tax cuts.

Take Action Contact your Representative and tell them to oppose this bill! House Targets for the Tax Bill – Center for Public Representation What to say: Please vote NO on the Tax Cuts and Jobs Act. This tax bill will hurt people with disabilities and their families. Tax reform should not be rushed. People should have time to understand the legislation and how they will be affected. Services that benefit people with disabilities and low-income Americans – such as Medicaid, Medicare, and Supplemental Security Income – are in danger of losing funding to help pay for these proposed tax cuts. Eliminating the individual mandate will reduce access and increase costs for people with disabilities and all Americans. Call your Representative Call the Capitol Switchboard at (202) 224-3121 or (202) 224-3091 (TTY) and ask to be connected to your Representative. Email your Representative Contacting Congress provides unique links to email your Representative directly. Tweet your Representative Twitter has become a powerful tool to communicate with elected officials directly. Find your Congress Members on Twitter and tell them to oppose these bills. House of Representatives Twitter Handles Sample Tweets to Fights Against Disability Attacks in the Tax Cuts and Jobs Act (TCJA) (developed by Access Living) 8.8 million households claimed medical deductions in 2015. Eliminating deduction vital to people with high medical costs is a #TaxOnDisability. Taking away medical deductions from seniors with greater medical needs, people with disabilities, and families with disabled kids is a #TaxOnDisability. Average deduction claimed is close to $10K; cost of long-term care could be $100K or more. Keep deduction, no to #TaxOnDisability #TCJA eliminates incentive for businesses to hire people with disabilities, including older Americans with disabilities. No to #TaxOnDisability Current tax credit for hiring a person with a disability can be as high as $2,400; ending the Work Opportunity Tax Credit is a #TaxOnDisability Eliminating orphan drug tax credit is a #TaxOnDisability. Older Americans and people with disabilities are more likely to have a rare disease or condition #TCJA Eliminating small business tax credit for increasing accessibility to employees with disabilities, older workers, and customers is a #TaxOnDisability The #TCJA may result in older Americans and individuals with disabilities paying more taxes on Social Security benefits. If seniors and individuals with disabilities can’t deduct medical expenses, many may need to use tax-deferred accounts. No to #TaxOnDisability #TCJA could kill investments in underserved communities that provide people with disabilities a place to live. No to #TaxOnDisability Eliminating deduction of state/local income, sales taxes from federal taxable income would squeeze state budgets No to #TaxOnDisability #TCJA could force massive cuts that block grant #Medicaid and damage state programs for people with disabilities. No to #TaxOnDisability   Tax Bill Disability Tweets – Center for Public Representation

Additional Resources Action Alert! Vote Likely this Week – Urge your Senators to Oppose the Tax Cuts and Jobs Act – AAPD Action Alert! Urge Your Senators to Vote NO on the Tax Cuts and Jobs Act – AAPD Action Alert! Don’t Let Congress Trade Tax Cuts for Medicaid and Other Essential Services – AAPD Here are 7 differences Republicans must resolve between their tax bills – The Washington Post Tracking the Congressional Tax Debate – Center on Budget and Policy Priorities (CBPP) How Does the Senate Republican Tax Bill Affect Your State? – Center on Budget and Policy Priorities (CBPP) Tracking the Congressional Tax Debate – Center on Budget and Policy Priorities (CBPP) Comparing the Latest House and Senate Tax Bills by Provision – Committee for a Responsible Federal Budget (CRFB) The Republican Tax Plan Is a Tax on Disability – Center for American Progress Action Alert – Urge Your Senators to Vote NO on the Tax Cuts and Jobs Act – Consortium for Citizens with Disabilities Death and Taxes: Dangerous Tax Reform Bill Introduced – Take Action Now! – National Council on Independent Living (NCIL) CCD Fiscal Policy Task Force Statement on House Tax Cut Bill – Consortium for Citizens with Disabilities (CCD) Joint Committee on Taxation Distribution Tables Confirm Skewed Priorities of House Tax Bill – Center on Budget and Policy Priorities (CBPP) Tax plan would hardly boost growth, add trillions to deficit: study – The Hill House Tax Bill Bad for Those Who are Aging and Disabled – Senator Bob Casey (D-PA) ASAN Opposes Tax Bill, Repeal of Individual Mandate – Autistic Self Advocacy Network

Action Alert: Urge Your Member of Congress to Co-Sponsor the TIME Act!

This Action Alert comes from the New York Association on Independent Living ...

H.R. 1377, the Transitioning to Integrated and Meaningful Employment, or TIME Act, would phase out Section 14 (c) of the Fair Labor Standards Act, which allows employers to pay workers with disabilities less than the federal minimum wage. This would also force vocational rehabilitation agencies across the country to find meaningful placements for people with disabilities in which their abilities could be maximized and in which they could be successful and valued.

The TIME Act currently has no co-sponsors from New York. Let's get the New York delegation signed on to this important bill!

Action

Email your Representative from Congress and urge them to co-sponsor H.R. 1377.

The following Representatives from NY signed on as co-sponsors last year, but have not yet signed onto the TIME Act, H.R. 1377 this year. Let's be sure to target these Representatives to sign on!

Rep. Louise Slaughter
Rep. Nita Lowey
Rep. Hakeem Jeffries
Rep. Peter King
Rep. Kathleen Rice
Rep. Eliot Engel
Rep. Nydia Velazquez
Rep. Sean Patrick Maloney
Rep. Paul Tonko

Click here to take action now!

Background

Current Federal law allows the Secretary of Labor to grant special wage certificates to entities that provide employment to workers with disabilities, allowing such entities to pay their disabled workers at rates that are lower than the Federal minimum wage. The practice of paying workers with disabilities less than the Federal minimum wage dates back to the 1930s, when there were virtually no employment opportunities for disabled workers in the mainstream workforce. Today, advancements in vocational rehabilitation, technology, and training provide disabled workers with greater opportunities than in the past, and the number of such workers in the national workforce has dramatically increased. In the 75 years since this became law, studies have shown that fewer than 5% of over 400,000 workers with disabilities ever transition out of segregated, subminimum-wage, sheltered workshop settings to integrated, competitive employment. This outdated model does not provide workers with disabilities with useful, marketable skills to obtain competitive, integrated employment in their communities.

Update and Action Alert On The Health Care Debate

The following message was sent by the Consortium for Citizens with Disabilities Grassroots Team:

Medicaid advocates,

There’s a lot going on right now, but we’re going to try and explain some of it--as you may have heard, the Senate held some votes today.

The Senate began by voting to start debate on healthcare bills this afternoon. That vote passed, with both Senators Collins of Maine and Murkowski of Alaska voting no. The Senate also voted on a slightly revised version of BCRA, with the horrible per capita caps on Medicaid. Due to procedural rules, the Senate had get 60 votes and did not. (Both Senators Portman and Capito voted for BCRA--they need to hear about how harmful this vote would be for their constituents with disabilities.) We anticipate that they will vote tomorrow on full repeal; this vote will not be the final vote. Please know this voting process will continue over the next several days with many different votes.

The process they're using moves fast—but currently, we think the Senate will be taking a FINAL vote THURSDAY OR FRIDAY. We do not know what that will be. It doesn’t matter. We’ll let you know when we know--until then you will hear a lot about other votes, but you should focus on advocating as hard as you can until this final vote.

The various bills have morphed and mutated multiple times over the course of the last few weeks, but one thing has stayed the same: any of these bills will absolutely destroy our healthcare system, and with it, the lives of millions of Americans with disabilities. Here’s a quick recap of what all of these bills do:

• No matter which version they vote on, millions of people will lose their health insurance.
• No matter which version they vote on, Medicaid will be cut by billions of dollars.
• No matter which version they vote on, millions of people with disabilities will have a harder time getting the health care and services we need.

If you’re feeling exhausted, scared, or overwhelmed, you’re not alone. This fight has been hard on us because of how important it is - and that’s exactly why we can’t give up now. These last days are critical. Here’s how we can win:

• Keep calling:
◦ Call your Senators and tell them to vote NO.
▪ Top Targets: Senators Capito (WV), Corker (TN), Heller (NV), Portman (OH), Graham (SC), Moran (KS), McCain (AZ)
▪ All Other Republican Senators
◦ Call and thank Senators Collins and Murkowski and ask them to stay strong.
◦ If you have already called, keep calling.
◦ If you have trouble with phone conversations, evenings are a great chance to call and leave a voicemail while offices are closed.
◦ If you use AAC, you can call in using your AAC device, or get a friend to read your message into the phone. After you call your Senators’ DC office, try their state offices. You can use our script:

My name is [your full name]. I’m a constituent of Senator [Name], and I live in [your town] and my zipcode is [zipcode]. I’m calling to ask the Senator to vote NO on any bill that caps or cuts Medicaid. If any of the bills being discussed as part of the budget process are passed, millions of Americans will lose health insurance. These bills take away protections that people with disabilities depend on, drastically cut Medicaid, and will return us to the bad old days when people with disabilities like [me/ my family member/ my friends] were uninsurable. We can’t go back. Please vote AGAINST repealing any form of caps or cuts to Medicaid. It’s time for Congress to scrap repeal, leave Medicaid alone, and work together to improve the ACA. We’re counting on you to do the right thing.

• Thank Senators Murkowski and Collins. Normally, we tell you not to contact senators from other states. But regardless of where you live right now, please thank Senators Collins and Murkowski through email, letters, posting on social media, etc. Just a “Thanks from us and from the entire disability community for your support for people with disabilities. Please stay strong and reject any bill that hurts Medicaid” is more than enough. They will be feeling the pressure from others and we need to to make sure they hear from the disability community to stay strong.

• Send emails and faxes. After you call, email your Senators and say the same thing. Then, send them a fax with that same message.

• Go to your Senators’ local offices and tell their staff what you think. To find your Senators’ local offices, visit contactingcongress.org. Under the contact information for each Senator, there is a list of their local offices. This is one of the most effective ways to get your point across to an elected official.

You may have heard or will hear people saying that a bill is dead or that a vote went well. But we’ve heard that before - people said the same thing about the House bill and we are now in the Senate. So don’t let down your guard - the Medicaid program remains at risk and harmful caps and cuts could very easily pass. We are the only thing standing in the way of these horrible changes. In the next few days, we have to call, email, show up, and advocate like our lives depend on it - because for many of us, they do.

In solidarity,

~The CCD Grassroots Team

Action Alert: Call your member of Congress today and urge them to vote NO on the Better Care Reconciliation Act (BCRA)

This Action Alert comes from the New York Association on Independent Living, (NYAIL) ...

The BCRA would repeal the Affordable Care Act (ACA) and threaten the lives and liberty of people with disabilities by making devastating cuts to Medicaid. The Congressional Budget Office (CBO) estimates that the BCRA would cut Medicaid by $772 billion and that 15 million people will lose Medicaid coverage over the next 10 years.

The BCRA would end Medicaid's over 50 year history of providing coverage to all who are eligible, and instead impose per capita caps. This means states will only receive set reimbursement rates, and if state spending exceeds that formula, the financial burden falls to the states. New York State has calculated that if BCRA passes, New York would need to come up with an additional $7 billion over the next four years in order to maintain Medicaid expansion coverage and offset per capita cuts. This would mean that New York would need to decide whether to limit the amount of services they provide, limit the number of people they cover, or some combination of both. Either way, the services we rely on to go to school, work, and live in our communities are at grave risk!

If the Senate passes the BCRA, the bill will then go back to the House of Representatives.

ACTION:

1.   Call your members of Congress TODAY at 844-898-1199 and tell them to say "no" to the Better Care Reconciliation Act and to end efforts to take away our health care. You will be routed to the appropriate representative.

2.   Share your story about how Medicaid or the ACA has affected your life to help advocates to educate policymakers about why this bill is bad news for Americans.

Health Care Questions: Recap

Here are the health care questions addressed over the last few days. Each has some explanation, and a list of links to further reading on the subject:

What's going on? And why?

What's the deal with "Pre-Existing Conditions?"

What's the argument over the "Medicaid Expansion?"

What are "Medicaid caps?"

Health Care Questions: How would all this affect home care?

Health Care Questions: How would all this affect home care?

Over the last several days, the NCC Blog has attempted to answer some basic questions about the current health care debate, especially as it relates to people with disabilities.

Read the posts so far:

What's going on? And why?
What's the deal with "Pre-Existing Conditions?"
What's the argument over the "Medicaid Expansion?"
What are "Medicaid caps?"

The final question of this series is ...

How would all this affect home care?

We might ask instead, "Why are the Republican health care bills so important to disabled people in a different way from everyone else?"

The two-word answer is: "Medicaid" and "home care."

Medicaid ...

We've already talked a bit about Medicaid Expansion, but not about Medicaid itself. Medicaid is a health insurance program operated and funded by the federal government and the governments of each state, covering a wide variety of medical services, mostly for people with very low income people. For the most part, recipients don't pay any premiums for Medicaid. Medicaid, along with Medicare which covers an overlapping population of elderly and disabled people, is the closest thing we have in the United States to a single-payer, government-funded health insurance program.

But Medicaid has a special importance for people with disabilities, because it is basically the only insurance that covers home care and a complex, essential array of other disability-specific services, like: physical therapy, speech therapy, occupational therapy, durable medical equipment, and even, in some cases, home accessibility modifications. Those of us who are disabled and on Medicaid not only can't survive without it, we can't live decent lives without it, even if we could, narrowly, avoid dying without it.

Home Care ...

A significant portion of the disabled community relies on some form of home care in order to remain independent and healthy. Let's be clear about what we mean by "home care." Home care is a very broad term that encompasses a variety of services and service approaches that may be different, but have certain key things in common:

Services are provided to a person with a disability ...

• By another person or persons ...

• For pay, under some kind of employer / employee structure, rather than a family connection or charity ...

• Authorized in some way by a medical professional, based on the served person's documented disability ...

• Provided in the disabled person's own home and / or other locations in their community, NOT in any kind of institution or facility.

When we're talking about home care, we generally aren't including other, equally important, but fundamentally different one-on-one disability services, such as: therapies, home nursing for recovery from acute illness, rehabilitation, or other services that are generally meant to be temporary, while home care is generally intended to be more or less permanent.

The other key thing to know about home care, is that while it is paid for in a variety of ways, the only consistent and complete source of funding for individual home care is Medicaid. Private insurance doesn't cover home care. Medicare doesn't cover home care. If you are very wealthy, you might be able to pay for home care out of pocket, but very few people can afford to do that over a whole lifetime.

How "capping" Medicaid puts home care at risk ...

There's nothing in either the House or Senate bills that specifically cuts funding for home care ... (but they both would eliminate important related projects, described below).

However, by limiting funding to Medicaid as a whole in each state, and setting the amounts available for each state in a way designed to ramp down funding by over $800 billion, both bills put home care at serious risk.

Any state could decide to cut or even stop covering home care, if and when their Medicaid budgets go over budget. Since home care is generally not viewed as "essential," (like emergency surgeries, hospitalization, and annual checkups), it would become a tempting target for saving money in a depleted state Medicaid systems.

Instead of disabled people having their services based on documented individual need and basic eligibility, they would be pitted against the other, often vastly different but equally compelling medical needs of every other Medicaid patient. Should a hard-up state fund home care, or pregnancy care? Occupational therapy, or cancer screenings? Suitable wheelchairs, or mental health? Every year, potentially in any state, the basic independence and well-being of significantly disabled people would be on the line in grubby, desperate competitions for adequate funding.

And make no mistake ... loss or even just reduction disability services would upend peoples' lives, and some people would die. Many of us live independently and successfully, but are just a few hours of daily service from institutionalization, or even death. There's no point sugar coating it.

On top of all this, repealing the Affordable Care Act, (ACA, a.k.a. Obamacare), would end extremely valuable programs ... like the Community Choice Option ... that have helped people move out of restrictive and expensive nursing homes, and into their own homes and communities.

This interview with ADAPT protesters spells out what's at stake:



Further reading ...

The GOP health care plan could force Americans with disabilities back into institutions
Ari Ne'eman, Vox.com - March 23, 2017

My Medicaid, My Life
Alice Wong, New York Times - May 3, 2017

I'm a Republican, and I depend on Medicaid
Jonathan Duvall, Pittsburgh Post-Gazette - June 26, 2017

Health Care Updates

Before finishing the series of questions on health care and the disability community, let's take a look at two related events that happened yesterday, June 22, 2017:

1. An initial Senate version of the American Health Care Act ... which is being called by the Senate the Better Care Reconciliation Act, (BCRA) ... was released by Senate Majority Leader Mitch McConnell's office. Here are three breakdowns of what's in the Senate bill at this point.

The Better Care Reconciliation Act: the Senate bill to repeal and replace Obamacare, explained
Sarah Kliff, Vox.com - June 22, 2017

Here is a chart from the Huffington Post comparing the Affordable Care Act, (Obamacare), the American Health Care Act, and the Better Care Reconciliation Act:

The New York Times also has a comparison chart, showing which provisions of Obamacare would be kept, eliminated, or changed under the Senate's Better Care Reconciliation Act:

How Senate Republicans Plan to Dismantle Obamacare
Haeyoun Park and Margot Sanger-Katz, New York Times - June 22, 2017

2. Almost the moment Sen. McConnell's office released the Senate bill, the disability rights organization ADAPT demonstrated against it at McConnell's office. Protesters were literally hauled away by police, and the scene was broadcast on both local and national news. In fact, later that evening, Rachel Maddow spent over 20 minutes on the protest and the reasons and history behind it ... including giving a rare retelling, to a mainstream audience, of ADAPT's history and the history of disability rights in America. Here's the segment. It's well worth watching and sharing (Click below to start the video):

Health Care Questions: What are "Medicaid caps?"

This week, the NCC Blog is attempting to answer some basic questions about the current health care debate, especially as it relates to people with disabilities.

Read the posts so far:

What's going on? And why?
What's the deal with "Pre-Existing Conditions?"
What's the argument over the "Medicaid Expansion?"

Today's question is ...

What are "Medicaid caps?"

• Medicaid is a federal entitlement. If you fit the criteria to qualify, and you sign up, then you can get whatever health care services you need. This may be limited by what your state will and won't cover, and what your doctors think you need, but it's never limited by a federal budget or how much health care other Medicaid recipients need. The amount the federal government spends on Medicaid depends entirely on how much health care Medicaid recipients need.

• One of the core elements of the American Health Care Act, (AHCA, a.k.a.: Obamacare), is to fundamentally change how Medicaid is funded, by capping the amount of money the federal government will give to each state for Medicaid each year. Formulas for this vary, but what's been proposed so far would not only limit Medicaid, but significantly reduce it, by over $880 billion over ten years.

• If federal Medicaid is capped, then each state would get a set amount of Medicaid funding each year. If needs are less than that, then fine. If they are more, then states wold have to figure out how to pay for them.

• This would create enormous pressure on states to cut back on services considered "extra" or "nonessential," like home care, community supports, physical therapies, etc. You can't subtract over $880 billion from Medicaid and expect no reduction in services. Waste, fraud, and abuse is at most a tiny fraction of that.

• In addition, the proposals so far would intentionally formulate the Medicaid caps to bring about substantial reductions in Medicaid into the future ... over $880 million over the next 10 years. The Republican's Senate bill might extend that time period a bit, or slightly reduce the cut, but the fundamental hit will remain.

• Limiting and cutting Medicaid ... and shifting more responsibility for it to the states ... would not be an unintentional side effect. Medicaid cuts and limitation are core goals of Republican health care policy.

Tomorrow we'll look at the affect Medicaid caps and cuts would have on the lives of people with disabilities.

The Senate Has a New Idea to Cut Medicaid That’s Even Crueler Than the House Plan
Jordan Weissmann, Slate.com - June 19, 2017

Medicaid works -- let's keep it that way
David Perry, CNN - June 20, 2017

The disabled will pay for the GOP’s Medicaid cuts
Julie Reiskin, The Hill - June 21, 2017

Republicans’ Obamacare repeal would be one of the biggest cuts to the social safety net in history
Max Ehrenfreund, Washington Post Wonkblog - June 22, 2017

Health Care Questions: What's the argument over "Medicaid Expansion?"

This week, the NCC Blog is attempting to answer some basic questions about the current health care debate, especially as it relates to people with disabilities.

Read the posts so far:

Monday: What's going on? And why?
Tuesday: What's the deal with "Pre-Existing Conditions?"

The next question is ...

What's the argument over the "Medicaid Expansion?"

• One of the provisions of the Affordable Care Act, (ACA, a.k.a.: Obamacare), was a program that enabled states to expand Medicaid to cover people with slightly higher incomes ... individuals with income up to 138% of the poverty line.

• This enabled about $14.5 million more people to qualify for Medicaid who couldn't before ... many of them working people without employer-provided health insurance, too much income to qualify for Medicaid previously, and not enough income to pay for individual insurance on the Affordable Care Act markets.

• The House version of the American Health Care Act would phase out the Medicaid Expansion over a period of x years. This means the federal government would gradually ramp down and finally stop compensating states for coverage of the newly added Medicaid Expansion enrollees. In order to keep covering these people, states would have to find a way to pay for it on their own.

• The Senate version of the AHCA will probably include the same phaseout of the Medicaid Expansion, except possibly sooner, or later, depending on how negotiations between Republican factions in the Senate turn out.

• Some Republicans and conservative policy thinkers have been saying that Medicaid Expansion under Obamacare actually harmed people with disabilities, (see Christopher Jacobs article below). The  argument is that adding more people to Medicaid took resources away from disabled people, causing waiting lists for services. This is completely false, since Medicaid Expansion was paid for by additional federal money, and therefore took nothing away from any other Medicaid recipients.

• On the other hand, if the AHCA does end the Medicaid Expansion, it would create a new funding crunch for participating states, since the federal funding for it would disappear. This could contribute to disability-related services being cut or curbed.

Further reading ...

Obamacare pushes nation's health uninsured rate to record low 8.6 percent
Dan Mangan, CNBC - September 7, 2016

A 50-State Look at Medicaid Expansion
FamiliesUSA - April, 2017

Medicaid Restructuring Under the American Health Care Act and Nonelderly Adults with Disabilities
MaryBeth Musumeci and Julia Foutz, Kaiser Family Foundation - March 16, 2017

House Republican Health Bill Would Effectively End ACA Medicaid Expansion
Matt Broaddus and Edwin Park, Center on Budget and Policy Priorities - June 6, 2017

Special Interests Obscure Truth That Expanding Medicaid Makes Disabled Americans Suffer
Christopher Jacobs, The Federalist - June 7, 2017

Health Care Questions: What's the deal with "Pre-Existing Conditions?"

Over the next several days, the NCC Blog will attempt to answer some basic questions about the current health care debate, especially as it relates to people with disabilities.

Read the first post here: "What's going on? And why?"

The next question is ...

What's the deal with "Pre-existing Conditions?"

You hear a lot about "pre-existing conditions" in all the recent news about health care. So what is it everyone is talking about?

• Pre-existing conditions are medical conditions a person has ... or had ... before signing up for health insurance.

• This is relevant to people with disabilities, because often, disabilities are pre-existing conditions. If you have had M.S., or paraplegia, or Down Syndrome, or some other disability before signing up for a new health insurance policy, the company will probably regard it as a pre-existing condition.

• Until recently, health insurance companies often refused to cover people with pre-existing conditions, or else charged them much higher premiums. The main reason for this is that they consider people who have been sick, or who have significant disabilities, as likely to cost a lot more in health care than "healthy" people. Many, if not most disabled people will cost more in health care than they will ever pay in health insurance premiums.

• Under the Affordable Care Act, (ACA, a.k.a.: Obamacare), health insurance companies are no longer allowed to refuse to cover people with pre-existing conditions, or charge them more for health insurance.

• The House's American Health Care Act, (AHCA), Includes an amendment that would not outright reverse this policy, but it would allow states to apply for a waiver, allowing them to permit insurance companies to charge higher premiums to people with pre-existing conditions.

This sounds complicated! What's it actually mean?

It means that if the AHCA passes, some states might allow insurance companies to go back to their older exclusionary practices, making it harder ... more expensive ... or impossible for people with disabilities to buy health insurance on the open market. This would probably affect people with disabilities:

• With moderate incomes ... lower income people usually qualify for Medicaid.

• Who are young people leaving their parents' insurance.

• Who are either unemployed or in entry-level jobs that don't include group health insurance.

• Who lose their private insurance, but can't qualify for either Medicaid or Medicare.

The House bill also includes something called "high risk pools," which would directly fund health insurance for people with pre-existing conditions who are shut out. The problem is that historically, high risk pools have been under-funded, and they are extremely vulnerable to budget cuts and neglect.

Most people with disabilities don't fit neatly into secure, generous benefits programs. Most of us at one time or another fall between the cracks. Yet, most of us can't afford to go without health insurance, even for a few weeks. Tinkering with the pre-existing condition rules, even without fully repealing them, is a very risky thing to do, and the consequences are potentially enormous.

Further reading:

How the GOP Health Bill Affects Sick People
Olga Khazan, The Atlantic - May 4, 2017

Here's what you need to know about preexisting conditions in the GOP health care plan
Glenn Kessler, Washington Post - May 4, 2017

Does new version of the AHCA protect coverage for pre-existing conditions?
Will Doran, PolitiFact - May 4, 2017

The CBO Says Trumpcare Won’t Cover Everybody With Pre-Existing Conditions
Ben Mathis-Lilley, Slate.com - May 24, 2017

Health Care Questions: What's going on? And why?

Starting today and continuing through the week, the NCC Blog will attempt to answer some basic questions about the current health care debate, especially in relation to people with disabilities.

The first question is ...

"What's going on? And why?"

The American Health Care Act (AHCA) passed in the House on May 4, 2017. The Senate, under Republican leadership, is working on its own version of the bill. To become law, it must pass the Senate, then the two bills would have to be reconciled, passed again, and sent to President Trump to sign.

The House AHCA bill would do several things, all of which would affect health insurance in direct and indirect ways. The most important aspects for people with disabilities are:

• Capping Medicaid, which means making it a limited, budgeted program rather than an open-ended federal entitlement.

• Cutting Medicaid by over $880 billion in 10 years.

• Letting states allow insurance companies to charge higher rates to people with pre-existing conditions.

• Phasing out the Medicaid Expansion, which allowed people with slightly higher incomes to qualify.

• Ending the Community First Choice program which supports home and community based services.

There are several reasons why this is happening, including:

• The Affordable Care Act, (ACA, a.k.a.: Obamacare), was unpopular from the start. Despite reducing the uninsured rate to an historic low, the ACA has had recent problems with high premiums and lack of insurance providers in several states and regions.

• Obamacare is deeply despised in particular by Republican and conservative lawmakers, who view repealing it as top long term political goal, and a core promise they made to their voters.

• Conservatives generally oppose government involvement in health care on principle. Republican control of the House, Senate, and Presidency have created a rare opportunity to not only repeal Obamacare, but also to drastically cut back longstanding government health care programs like Medicaid.

• Although the two goals aren't formally connected, it's worth noting that if and when the AHCA is passed and made law, the Trump Administration's next big priority is to pass massive tax cuts, especially for higher income Americans.

In summary, the current debate is influenced by a combination of partisan political ambition, ideology, greed, and ... to some extent ... an genuine need to make health care better, more affordable, and more equitable.

Three more points:

• So far, the AHCA bill is very unpopular with the public, while the ACA ... Obamacare ... has become a good deal more popular after the November election, when President Trump's election made repeal more likely.

• The Congressional Budget Office, which analyzes the costs and benefits of all bills in Congress, estimates that the AHCA would result in 14 million fewer Americans having health insurance over 10 years, while the federal budget deficit would decrease by $337 billion.

• Senate Republican leadership hopes to pass the AHCA by July 4th, and is apparently bypassing the usual committee and hearing process, hoping to come to an agreement in secret, and get it passed quickly.

Tomorrow's health care question: What's the deal with "pre-existing conditions?"

Further reading:

We asked 8 Senate Republicans to explain what their health bill is trying to do
Tara Golshan, Dylan Scott, and Jeff Stein, Vox.com - June 16, 2017

Americans overwhelmingly like Obamacare more than Trumpcare
Bob Bryan, Business Insider - May 16, 2017

NCIL Statement on House Passage of the American Health Care Act
National Council on Independent Living - May 5, 2017

House Passes Health Care Bill Alarming Disability Advocates
Michelle Diament, Disability Scoop - May 4, 2017

American Health Care Act
Congressional Budget Office Report - March 13, 2017

Paratransit Update

The Clinton County Legislature Transportation Committee voted last night, June 12, to have the Planning Department draft a written plan for proposed elimination of paratransit in "greater Plattsburgh." The Committee also agreed that there will be further public comment meetings on the plan once it is written. We will let everyone know as soon as the Planning Department has a completed written plan, possibly in July, as well as how and when the public can comment on it.

In the meantime, you can still sign the online petition, and encourage others to sign it as well ... especially people with disabilities who use Clinton County paratransit.

Change in para-transit system moves to planning stage: People with disabilities fear loss of independence
Dan Heath, Press-Republican - June 12, 2017

#SaveOurBusSystem ... Updates

The Clinton County Planning Department's proposal to eliminate paratransit has generated a lot of concern and advocacy activity.

People with disabilities who rely on paratransit wonder how they will be able to navigate the regular routes. The buses are accessible, but here in the North Country at least, fixed routes don't cover much territory, even with route deviation. And in the middle of winter, or a summertime downpour, a "short" jaunt to a bus stop is often way too much for a wheelchair user, blind person, or someone using a cane or walker.

These questions are being noticed by local media:

Clinton County bus service for disabled people could be eliminated this summer
Zach Hirsch, North Country Public Radio - June 2, 2017

Para-transit riders: Don't take away our independence
Joe LoTemplio, Press-Republican - June 5, 2017

Clinton County could eliminate public paratransit routes
Liz Strzepa, NBC 5 - June 5, 2017

The Clinton County Legislature's Transportation Committee will meet on June 12 to make a preliminary decision on what to recommend to the full Legislature.

What can you do to let your view be known?

• Contact your Clinton County Legislator.

• Attend the June 12 Transportation Committee meeting, which is open to the public.

• Write a Press-Republican Letter to the Editor.

• Sign the Change.org petition.