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The Grassroots Coalition
On Social Security Work Incentive
 and Health Care Reform

                    We have a problem and we are going to fix it.DRAFT MEMO TO THE "GRASSROOTS COALITION"
December 2, 1997

Dear Disability Rights Advocates:

This letter follows up on the call you received regarding our
teleconference scheduled for Monday, December 8th at 1:30PM Pacific
Standard Time. The memo is co-written by a benefits counselor who,
as an amputee, has always had the health care he needs to remain
employable. It is co-written by a policy analyst who is a
psychiatric survivor dedicated to the removal of the barriers under
discussion for all disability groups.
 
THE VERY GOOD NEWS

Washington legislative staff in both Houses of Congress have been
working for over a year on various forms and levels of reform in
health care access after employment, Work Incentive reform and
consumer choice of alternate rehab providers for people with
significant disabilities who receive SSDI and SSI. The staff belong
to Senator Kennedy, D, MA, and Senator Jeffords, R, VT, in the
Senate and Representatives Bunning, R, KY, and Kennelly D, CT, in
the House of Representatives.

It is highly likely both Houses will introduce employment related
legislation from these Members of Congress covering critical
employment and health care issues in late January. Connie Garner of
Senator Kennedy's Office has shared that they are working on the
possibility of President Clinton raising this policy issue in his
State of the Union speech in January

The new Commissioner of Social Security, Kenneth Apfel, spoke to
the November SSA Employment Conference in Washington and stated
that he thought health care should be employment neutral for people
receiving SSDI and SSI. He will spend a morning next week at the
Center for Independent Living, Berkeley/Oakland, listening to what
consumer advocates think needs to change in these areas. We have
unofficial word he has stated that he wants to be the "return to
work Commissioner."

THE GOOD NEWS

The legislative staff have spent many many hours with community
representatives and consumers and other lobbyists trying to first
understand the complicated baseline of existing regulations and
then, hoof to improve them in a budget neutral federal environment.
Many believe they are working in good faith and we believe they
are, for the most part.

Elements under serious debate in the two legislative initiatives
include:

WORK INCENTIVES-Kennedy/Jeffords Bill,
"Work Incentives Improvement Act of 1998"--late November draft

 A 2 for 1 dollar offset formula of cash benefits for people who
work and receive SSDI, similar to the current 1619a and b Program
in SSI. November draft has this in a 10 state demo only.

 Work will not trigger a Continuing Disability Review (CDR).

* Work activity will be not be used as a determining factor in CDR
decisions.

 Transportation costs become allowable Impairment Related Work
Expenses for all disability groups, including car purchase.

ACCESS TO HEALTH CADRE AFTER EMPLOYMENT Kennedy/Jeffords Bill--late
November draft

 Affordable Medicare buy-in set up after an employee reaches
certain income thresholds.

 Affordable Medicaid wrap buy-in allowed for people who receive
SSDI and work. Medicaid wrap available to 'tap' around private or
employer health care insurance.

 Affordable Medicaid buy-in for people who receive SSI and work
and reach the current 1619b income thresholds. [Consider
elimination of current individualized thresholds for a universal
buy-in for all SSI eligibles who can access this buy-in.

CONSUMER CHOICE IN REHAB PROVIDERS

 [Bunning Bill] Give consumers/beneficiaries responsibility for
choosing among providers of employment services, both public and
private.

 Reimburse providers upon attainment of milestone outcomes, e.g.,
after completing training, after job placement, after period of
time on the job.

 Strong 'philosophical' support for the 2 for 1 dollar offset
formula in SSDI, BUT, they want 'pay fors'.

THE REAL NEWS

Compromise is the name of the game in DC. Time is either short or
running out in terms of knowing ahead of time what the minimum
consumer position might be, should be, or would be on these issues.
In DC, there are reality checks and budget constraints that will
force all the legislative players to cut deals. We need to know how
far those deals can or cannot go before we mend up with useless
legislation impacting none of the barriers consumers face with the
Social Security Work Incentives and access to health care after
employment.

SOLUTIONS

We are going to continue die road to that consensus on December 8*
with the first teleconference. Many stakeholders and advocates are
working very hard out there but too alone and disjointed from one
another. We want to bring some structure and support to the policy
discussions that we know are happening all over the country which
are energizing the current level of activity in Washington.

Sincerely,


Andy Imparato
Director of Policy,
National Council on Disability


Bryon R. MacDonald
Benefits Counselor,
Center for Independent Living, Berkeley/Oakland

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