Wall Street Journal - October 22, 1999
Bill Inspires Disabled to Work, Fuels Hiring in a Tight Market
By JOSHUA HARRIS PRAGER Staff Reporter of THE WALL STREET JOURNAL
Seven years ago, multiple sclerosis forced Karen Huber to quit her job teaching English at Western Wyoming College, leaving her saddled with medical costs of $6,000 a month and forcing her onto the government dole.
Ms. Huber's condition has improved over the years, to the point where she no longer uses a wheelchair and even takes mile-long walks. But she hasn't been able to return to work -- not because of physical impairment, but for fear of losing her government health coverage.
For years, the disability community has lived in dread of "the cliff," the earnings point-of-no-return beyond which government benefits are permanently taken away. Under current regulations, disabled people who earn more than $700 a month -- well below the poverty line -- are ineligible for Social Security Disability Insurance; three years after they start earning that much, Medicare cuts out. They would still be eligible for Medicaid, but would have to meet certain poverty qualifications limiting their assets. If their annual salary exceeded roughly $18,000 -- an amount that could be swallowed up by medical costs in just a few months -- they would lose Medicaid.
New Safety Net
But all of that is about to change. Earlier this week, the House of Representatives voted 412-9 in favor of legislation that allows people with disabilities to go to work without losing their government health benefits. With the Work Incentives Improvement Act now headed to a joint committee of the House and Senate, there's bound to be wrangling over funding, which is expected to top $750 million over five years.
However, the bill has enjoyed tremendous bipartisan support -- the Senate version passed in June with a vote of 99-0 -- and has been a favorite issue of President Clinton's. Supporters of the bill are hopeful he will sign it by Christmas.
In anticipation of the change, scores of disabled people across the country, most unemployed for years, have begun dusting off their resumes and reconsidering careers. Ms. Huber, suddenly nervous and giddy at the age of 47, now spends early mornings in her home in Casper, Wyo., poring over the help-wanted ads in the Casper Star-Tribune. She has applied for jobs as a college adviser, librarian, curriculum planner, university administrator, and for a writing residency. "Whether it's dishwashing or directorship," she says, "I need to attempt this for the person I think I still am."
The Job Hunt
Lesslie Williams of Kula, Hawaii, hasn't worked full-time in the 13 years since learning of her mixed connective tissue disease. But now she is advertising online for her skill as a Web-page designer, and has started doing free-lance work. And Jim Rice of Shawnee, Okla., a former construction worker who has been unemployed since he suffered a spinal-cord injury in a car accident three years ago, has applied for management slots at a local Lowe's Corp. home-improvement store. "I could at least be the boy by the door who rolls around and shows people where things are," he says.
With national unemployment running at 4.2% in September -- the lowest rate since 1970 -- employers are eager to tap the ranks of the nation's estimated 15 million severely disabled people, nearly three-quarters of whom don't work. Among the severely disabled who are in the labor force, unemployment is a relatively low 4.6%, according to the Bureau of Labor Statistics.
Since June, there has been a 50% jump in corporate requests for resumes from the National Business and Disability Council in Albertson, N.Y., which maintains a database of disabled workers and serves more than 200 major corporations, including Microsoft Corp. and Merrill Lynch & Co. "It's a change from, 'Is this a nice thing to do' to 'Is this a smart thing,' " says the group's director, Ben DeYoung. "It's a tight market."
The Congressional Budget Office estimates that the new law will prompt only about 35,000 disabled adults to join the work force over the next decade. But advocates for the disabled think that estimate is way too conservative.
Paul Spooner, president of the National Council on Independent Living, which represents 250 federally funded disability centers that have been busily notifying their clients of the impending change, says that half of the roughly 11 million people with severe disabilities who aren't working now could join the labor force over the next five to 10 years. As proof, he points to the success of the welfare-to-work program, which is cited -- along with the roaring economy -- for slashing in half the number of welfare recipients during the past five years to 7.3 million.
The old regulations, several of which were adopted under the Balanced Budget Act of 1997, were clearly intended to help severely disabled people who couldn't work make ends meet. But they provided scant opportunity for severely disabled people who could work to do so without losing their benefits.
Under the House bill, disabled people will be eligible for Medicare for 10 years from the day they go back to work, no matter what their salary; the Senate version grants indefinite eligibility, as long as the person begins working in the next six years. Moreover, in states that choose to do so, disabled people will be able to pay monthly fees, scaled to their salary, for Medicaid coverage. The fees aren't yet set, but are expected to top out at a few hundred dollars a month.
Still to be reconciled between the House and Senate versions of the bill is the question of whether participants in the buy-in program should be subjected to an annual salary cap. The House has proposed a cap of about $35,000, while the Senate has opted for no cap.
Rick Lazio, New York's Republican Congressman who sponsored the House's version of the bill, says that the government simply may not be able to afford the Senate's no-cap plan. "The issue is much more about financing than it is philosophy," he says. But William V. Roth Jr., the Republican chairman of the Senate's Committee on Finance, counters that the House bill would gut the proposed law. Recipients of the buy-in programs "would fall off the very benefits cliff we are trying to eliminate," he says.
The new legislation has its opponents. "It's being presented as if people with severe disabilities are now going to be able to go to work. But the services that severely disabled people need aren't covered under Medicaid state plans," says Richard DiPeppe, director of an independent-living center in Norfolk, Va. Mr. DiPeppe says that what is truly needed is a national attendant-care program that would help disabled people get out of bed, dressed and off to work.
A Second Chance
Despite such concerns, many disabled people see the measure as a second chance at a career. In 1993, Lucinda Harman was earning $65,000 as the director of nursing at a psychiatric hospital in Hawaii, when a spider bite exacerbated a rare genetic disorder she has that is called Ehlers-Danlos syndrome. Suddenly, Dr. Harman needed around-the-clock care and extensive hospitalizations. For two years, the medical bills topped $500,000, and after her worker's compensation ran out, she was forced to leave her job and collect both Medicare and Medicaid.
Even when her condition stabilized, her annual bills for therapy, oxygen, attendants and medicines topped $100,000, and she couldn't risk surpassing the $8,400-a-year earnings cliff. Like many disabled people, she volunteered her services, founding Combridge Inc., a nonprofit educational-consulting firm in her native Belton, Texas. She also began teaching part-time at nearby University of Mary Hardin-Baylor.
Dr. Harman, 47, says that once the law takes effect, she plans to give herself a $1,000-a-month salary at Combridge. She also has been accepted to a neuropsychology internship program at a rehabilitation center in Austin that will pay her between $15,000 and $18,000. And she will increase her teaching load, more than doubling her salary to about $15,000 a year.
State Bait
The law will provide states with incentives, including "infrastructure grants" of at least $500,000, to establish the Medicaid buy-in programs. Already, since February, six states have readied the programs. "States know that the cost of providing this ongoing Medicaid coverage will be more than offset by the savings in food stamps, housing assistance, fuel assistance, cash assistance," says Peter Baird, director of Vermont's new Work Incentives Initiative Project, which hopes to launch a buy-in program in January. "That's why we jumped aboard."
In 1996, Mr. Baird was among the first to lobby his senator, James Jeffords of Vermont, about the need for a bill to address the issue of unemployment among the disabled. At the time, backers were emboldened by the Americans with Disabilities Act of 1990, which mandated access for the disabled in all walks of life. Sen. Jeffords was a good choice: In 1975, the moderate Republican had co-authored a bill on education for the disabled, and three years later had promoted another bill making federal buildings accessible.
In July 1996, the senator introduced a work-incentives bill that attempted to make the cliff less precipitous, by shrinking Social Security payments to the disabled as their incomes increased, rather than simply cutting them off. But the bill, which sought an estimated $5.1 billion in funding over five years, died without a vote.
Spotlight on the Issue
Still, his efforts helped bring the issue out in the light. That fall, the Social Security Administration co-sponsored its first annual employment conference on people with disabilities, and the Government Accounting Office released several studies looking at barriers preventing the disabled from re-entering the work force.
In December 1996, several advocacy groups for the disabled convened in Washington, D.C., and Oakland, Calif., to push the idea of Medicaid buy-in programs. Consensus emerged that the main roadblock to employment was the federally mandated salary cliff. "It wasn't the job, it wasn't the employee, it wasn't the employer," says Bryon R. MacDonald, chairman of the National Council on Independent Living's Social Security subcommittee. "It was the alphabet soup of government bureaucracy."
Just ask John McNeal. By 1996, six years after a motorcycle accident rendered him a quadriplegic, the former construction-project manager was desperate to work. And so, after years of being bombarded daily by telephone sales pitches, Mr. McNeal, then 28, got a job in telemarketing. But when Mr. McNeal told a local counselor about it, he was disappointed to learn he could only work four, four-hour days a week or he would lose his health insurance.
'Fast, Flawless and Friendly'
Nonetheless, he took the position, working from his father's home in Dover, Del., selling accidental death and dismemberment insurance over the phone. "You can understand why I was good at it," he says, laughing. Mr. McNeal notched more sales than anybody else during his first weekend at work, and in seven months on the job won three "Fast, Flawless and Friendly" awards.
But as Mr. McNeal earned extra money for his hefty sales, he had to trim three hours from his workweek so he could still receive Medicaid. Discouraged, he quit after nine months. "What an incredible disincentive," he recalls. "It was the worst feeling in the world."
Countless jeremiads like Mr. McNeal's led the National Council on Disability in February 1997, at its annual conference in Houston, to draft a document, "Removing Barriers to Employment for the 105th Congress and Beyond." A year later, the document served as the blueprint for Sen. Jeffords's new work-incentives bill, which now centered squarely on access to health care.
"One out of every four families has someone in it who's disabled. Politically, [passing the bill] was the thing to do," Sen. Jeffords says now. The senator notes that Bob Dole, who testified this year before the Senate finance committee about the bill, helped tremendously. "It made a huge difference in getting people to understand the stupidity of these barriers."
Resumes and Interviews
The initial response from the disability community has been strong. Of the 1,200 people represented by MKBN Services Inc., an Allison, Iowa, consulting company for people with disabilities, 75% have indicated that they plan to work full-time once Iowa initiates its Medicaid buy-in program in March.
"I've had folks call me and say, 'Kath, can you help me write a resume?' " says Katherine McInnis-Meisner, director of a mentoring program for women and girls with disabilities in Portland, Maine. "They ask me, 'What do I wear [to an interview]? Can they ask me about my disability?' "
Meanwhile, Ms. Huber continues poring over the help-wanteds in the Casper Star-Tribune. She has had one rejection so far and is awaiting word on her other applications. But she says she already knows what she'll do when she gets her first job offer.
"One of the biggest joys in my life," she says "will be to go to the Social Security office" and turn down the monthly check she has been receiving in lieu of a salary. She intends to say, "I have a job now. Thank you, but no thank you."