JFActivist

Olmstead Anniversary Stirs Up Interest in Long Term Services and Supports

From the JFA Moderator (6/22/09):

With events big and small occurring all over the country in honor of the 10th Anniversary of the Olmstead decision, both the media and public officials sat up and took notice of our communities long ignored demands for Long Term Services and Supports as a means to full-inclusion in the community.

For media coverage, see the articles posted below:

From The Progressive

“10th anniversary of freedom for people with disabilities”

By Mike Ervin, June 21, 2009

http://www.progressive.org/mpervin062109.html

 

From ProRepublica

“Nursing Homes Get Old for Many With Disabilities”

by Jennifer LaFleur

http://www.propublica.org/feature/nursing-homes-get-old-for-many-with-disabilities-621

From the Hartford Courant

"Olmstead Supreme Court Anniversary"
Photo coverage by Richard Messina

Disability advocates marched to the State Capitol to commemorate 10th anniversary of Olmstead Supreme Court decision requiring the state to provide opportunities for people with mental disabilities to live in the community in group homes if they can fare as well as in state hospitals.
http://www.courant.com/news/local/hc-march-2-capitol-pictures,0,6352804.photogallery


For upcoming and past events as well as resources for organizing your own event go to AAPD's Olmstead website http://www.aapd.com/olmstead/aboutolmstead.html

CBO Estimates for Health Care Reform Incomplete

From the Center on Budget and Policy Priorities (6/16/09):

SOME MEDIA REPORTS MISCHARACTERIZE CBO
ESTIMATE OF SENATE “HELP” HEALTH REFORM BILL
Final “HELP” Bill Likely to Cover Many More People
Than Partial Draft CBO Analyzed
by Paul Van de Water and Robert Greenstein

The news media are widely reporting that, according to a partial and preliminary Congressional
Budget Office (CBO) analysis, health reform legislation that the Senate Committee on Health,
Education, Labor, and Pensions (HELP) is developing would cut the number of uninsured by only
16 million people while costing $1 trillion over ten years. That conclusion, however, is incorrect.
The CBO analysis covers only a part of the HELP plan (the parts for which the Committee gave
CBO detailed specifications) and does not include major elements of the plan that would further
substantially reduce the number of uninsured.

Consequently, the CBO analysis is highly incomplete; it does not show, nor does it purport to
show, the effects that the full HELP plan would have on either health insurance coverage or the
federal budget. As CBO itself noted, the provisions of the HELP plan that it did not cover “could
also have substantial effects on our analysis.”

The CBO analysis does not cover key features of the HELP plan, including:
1.  Medicaid Expansion. About 40 percent of all uninsured people are in families with incomes
below 150 percent of the poverty line, and the Committee proposes to cover these low-income
people by expanding Medicaid. The CBO analysis does not reflect this element of the Committee’s plan. The CBO analysis also does not incorporate a planned provision to require states to maintain
current Medicaid eligibility levels in cases in which states already exceed the new federal
Medicaid coverage requirements that the bill would establish. As a result, CBO assumed many
states will reduce Medicaid eligibility and shift some of their new beneficiaries into a proposed
new health insurance “exchange,” at increased federal cost. Including these Medicaid
provisions in the estimate will both greatly increase the number of people with coverage and
reduce the cost per newly insured individual, although it will increase the cost of the bill as a
whole since many more of the uninsured will gain coverage.

2. Employer Responsibility. The Committee will likely include in its bill a requirement that larger
employers either offer health insurance coverage to their employees or make a payment to help
pay for coverage. This requirement will increase the number of people with employer sponsored
health insurance and reduce the cost of government subsidies for coverage
purchased through the exchange. In addition, the CBO estimate does not include the bill’s
provision to allow some employers to purchase coverage through the exchange, which also
would likely increase the number of people obtaining coverage through their employer.

3. Individual Responsibility. As CBO acknowledges, the Committee plans to require that individuals obtain health insurance coverage (that is, impose an “individual mandate”), but CBO found the draft language for this provision “ambiguous.” The bill does not specify the size of the
penalties for non-compliance, but gives the Treasury Secretary the authority to set them. CBO
assumed that the penalties would be minimal, thus making the mandate less effective. A
toothless mandate is not, however, what the Committee appears to have in mind. By assuming
such a weak mandate, the CBO estimates likely understate both the extent to which the
Committee plan will encourage uninsured individuals to purchase health insurance and, in turn,
coverage gains under the bill.

4.  Public Plan Option. The CBO estimate does not assume the availability of an option for
individuals to choose a new public plan that would compete with private insurance plans within
the exchange. The Committee plans to include a public plan. Depending on its structure, a
public plan option could help slow the growth of health costs and reduce the cost of the new
federal health insurance subsidies.

5. Other Omissions. The CBO analysis does not reflect several other elements of the Committee
proposal that would reduce costs or increase coverage. For example, CBO found the draft
provisions regarding income verification to be “unclear,” which CBO said affected its estimate
of the cost of the subsidies. The CBO analysis also does not take into account the proposed
requirement that insurers offer dependent coverage for children of policyholders who are less
than 27 years of age.

In essence, the CBO estimate covers only a part of the emerging HELP bill, and its findings about
cost and coverage may differ substantially from what CBO finds when it analyzes the full legislation
that the Committee issues. Observers would be well-advised to await such analysis before drawing conclusions about the legislation.

In A Fight for Our Lives: Health Care Action Alert

From ADAPT (6/18/09):

We are now, in a fight for our lives, to include the Community Choice Act

(CCA) in health reform. We are working to have CCA added to health reform, as a demonstration project.  What this means is CCA, the whole bill including the mandatory benefits, would happen in around 5 states.  This would allow us to test the bill (no institutional bias) and provide concrete answers to the questions and issues we keep running into such as run-away costs and cross-disability services.

We must create a nationwide tidal wave to get CCA added as a demonstration project. The ADAPT army and other disability activists and advocates can lead the way to get this done, if we massively act now.

Our best chance to get this win is to get the House to add the CCA demonstration to the House health bill.  Representative Danny Davis office has been very helpful. Thanks everyone for your hard work. Here is what we need to do:

1.  Call YOUR Representative, http://www.house.gov/ , and ask that they support including a CCA demonstration project to the House health reform bill.  Also, if any of the Democratic Energy and Commerce Committee,

http://energycommerce.house.gov/index.php?option=com_content&view=category&layout=blog&id=160&Itemid=61

 members are from your state, contact them, too! The demonstration would be for CCA as a whole in around five states. The purpose of the demonstration would be to test the assumptions of the bill including that it would be cost effective, that the new cross-disability, cross-age services would work well, etc.

Your Representatives and the Committee members from your state, should contact House Energy and Commerce Committee Chairman Henry Waxman,

http://energycommerce.house.gov/index.php?option=com_content&view=category&layout=blog&id=159&Itemid=87

and let him know that they support adding CCA to the House Health Reform bill.  If YOUR Representative is a member of one of these committees, below (Energy and Commerce or Ways and Means) then it is incredibly important that they do this!

2.  Ask your Representative, especially if they are on one of these committees, to sign the letter being circulated by Representative Davis.

 

Action Alert: Moment Of Truth For Health Care Reform, Contact Senate THIS WEEK

From NCIL (June 20, 2009):

Urging All Disability Advocates to Act Immediately!

The Time Is Now to Include Long-Term Care in Healthcare Reform Legislation!
Call Your Senators This Week – our chance to make a difference is slipping away!

For the last few months, NCIL has been working long hours to stay up on the events, questions and dialogue surrounding the healthcare reform debate. NCIL has been busy educating its members and members of Congress about the importance of including Long-Term Care Reforms in the Health Care Reform legislation. All of this effort has led us to this dramatic moment in the history of our Movement to free our brothers and sisters and bring equality and access to all people with disabilities!

The Finance Committee and the Health Education, Labor and Pensions (HELP) Committees are the two Committees in the Senate who have jurisdiction and responsibility to draft and approve a piece of legislation that will overhaul our nation’s healthcare system. The House of Representatives has three Committees that hold the same responsibility, but for now we are focusing on the Senate. It is this opportunity that NCIL feels may be our only chance in the next several years to seriously address the institutional bias in Medicaid, create long-term care insurance that doesn’t require people to be or become impoverished, eliminate the unfair 2-year wait period for Medicare, and ensure access to medical and diagnostic equipment in medical offices along with the cultural competency of medical and dental professionals.

NCIL strongly believes that the political and financial costs of overhauling our healthcare system will leave little or no ability for the Federal Government to take on our priorities after this process is complete. In addition to that belief, NCIL is adamant that reforming our healthcare system is not complete unless we address the problems and inequities that exist for people with disabilities in the current healthcare and long-term care systems. That is why we need all of you, throughout the nation, to get on the phone, send an e-mail or fax, and make our message loud and clear!

What has been done so far? The Finance and HELP Committees have both released preliminary drafts of their legislation, but have not yet released final drafts. The Senate HELP Committee included the CLASS Act in their version, as well as language from the Promoting Wellness for People with Disabilities Act. This is a great start, but does not mean that the language will stay in the final draft, or end up in the final version sent to the floor of the Senate for debate and a vote! The Finance Committee released a draft at the end of May, and they included two proposals for completely eliminating the two-year wait for Medicare. NCIL was vocal in support of those proposals, but Senators need to hear from constituents. What was missing from the Senate Finance draft was language to end the institutional bias in Medicaid, which is found in the Community Choice Act (CCA). This is not acceptable, and we must all tell this to the Senate. There is opposition to this in the Senate because of the cost. The Congressional Budget Office (CBO) finally corrected their horrendous estimate (known as a “score”) of the CCA, but it still lies around $6 Billion dollars per year. Because Congress needs to have healthcare reform legislation paid for, before approved, there is reluctance to include this “pricey mandate”. But we all know the “price” of not including the language of the CCA, and that is why we need to tell our Senators that our priorities need to be a part of the reform!

What is the Message? This is very simple. We need every Senator, especially those Senators who serve on the Senate Finance and HELP committees to know the following: Any healthcare reform legislation must include the language of the Community Choice Act, the CLASS Act, the Promoting Wellness for People with Disabilities Act an language that will end the two-year wait for Medicare. Healthcare reform is not truly reform for millions of Americans if these priorities are not included!

What do I do? Contact your Senator THIS WEEK. We are not kidding about this. Both Committees are drafting and marking up their own pieces of legislation right now. Once both Committees have final drafts, they will work on creating a compromised version to be sent to the entire Senate, where it will likely face amendments, and ultimately a vote. It is MUCH EASIER to get your priorities into the legislation at this point in the process, than fighting for an amendment or another method after the official bill has been introduced.

Spread the Message: Contact the Media! We also strongly encourage you to reach out to as many people in your region as possible with our message – our time is now! If you’d like to reach the media with your thoughts, five sample letters to the editor are available through NCIL or the AAPD website at http://www.aapd.com/olmstead/resourcesolmstead.html#letters. Special thanks to the staff of the Center for Disability Rights in Rochester New York for creating these sample letters and for their incredible dedication to the Movement!

I need more information!

•  To learn more about the language we want included in the healthcare legislation, review pages 5-6 of the NCIL Legislative and Advocacy Priorities (PDF or Text-Only).
• Visit http://finance.senate.gov/sitepages/committee.htm to see if your Senator is on the Senate Finance Committee.
• Visit http://help.senate.gov/About.html to see if your Senator is on the Senate HELP Committee.
• Visit http://www.senate.gov/general/contact_information/senators_cfm.cfm to find out how to contact your Senator.

If you have questions about healthcare reform, our message, or just not sure what’s happening here, please contact Jason Beloungy, NCIL Healthcare Policy Analyst, at 202-207-0334 (toll-free 1-877-525-3400), ext: 1008, or e-mail Jason at: jason@ncil.org.

Organize for Olmstead - 10 Years Out

From the JFA Moderator:

One Week Out: Organize for Olmstead's 10th Anniversary

The Supreme Court's Olmstead decision was on of the most significant events in our community's recent history.  It upheld the "integration mandate" of the Americans with Disabilities Act (ADA), requiring public agencies to provide services "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." This ruling promised to change the lives of all people with disabilities by requiring states to provide community-based options and individual choice. It's been 10 years and we are still waiting!

So on or around June 22, 2009, in statehouses, nursing homes, blogs, schools, centers for independent living, neighborhoods, chat rooms, and homes across the United States, we will unite as one voice to celebrate that decision and demand its FULL enforcement.  There are currently events of varying sizes planned in

TX, OH, MA, CA, DC, GA, IL, MI, and NC.

For information on these events and for suggestions or resources for planning an event of your own, go to http://www.aapd.com/olmstead/

A few suggestions include:

• Sign the AAPD Health Care Peition with your friends
• Get a group of people to go visit a nursing home, remember why this fight must go on
• Have a rally or press conference at HHS office or state building

Olmstead's Anniversary and Disability Civil Rights

From Steve Gold's Information Bulletin (6/8/09):

Olmstead's Anniversary and Disability Civil Rights
By Steve Gold

June 22, 2009, marks the 10th anniversary of the Supreme Court's Olmstead ruling for disability civil rights. Some people have made an analogy between the Olmstead decision and the Brown v. Board of Education decision in 1954. Let's compare them.

Nearly ten years after the black civil rights movement's victory in Brown, incremental, albeit not overwhelming, progress had occurred.  Nonetheless, some people thought the black civil rights struggle had stalled.

Nearly ten years after the disability civil rights movement's victory in the Olmstead decision, incremental progress has occurred as well.

But still, more than 313,000 people with disabilities in nursing homes (23% of the total) want to live in the community, and yet are denied their civil right to integration, primarily because of Medicaid's historical bias in favor of segregation.  Many of them are on "waiting lists" for their civil rights. Can you imagine a "waiting list" for black civil rights?

While the black civil rights movement achieved its share of victories, it took the March on Washington for Congress to enact both the Civil Rights Act of 1964 and the Voting Rights Act of 1965.  And even then, it took the U.S. Department of Justice to take the right actions and really enforce these civil rights.

Remember that Title VI of the 1964 Civil Rights Act prohibited federal subsidies for racially segregated institutions.

So why not similarly rectify segregation for people with disabilities? Does not the Olmstead decision, together with the ADA/Section 504, already provide the necessary handles to prohibit federal subsidies to States that limit services only to segregated institutions, thus denying real choices that would enable 313,000 people to reside in the community.

Some say the disability civil rights issue of ending unnecessary segregation must wait.  But as Dr. King wrote, "For years now I have heard the word 'Wait.' It rings in the ear of every Negro [person with a disability who is unnecessarily institutionalized] with piercing familiarity.  This 'Wait' has almost always meant 'Never'."

Last year when some disability advocates wanted an explicit reference to ending unnecessary segregation included in the ADA Restoration Act, they were politely told that other issues were the focus:  "wait."

This year when people with disabilities with the lowest incomes, who are entirely dependent on Medicaid, have demanded to end unnecessary segregation by having the Community Choice Act included in any health reform legislation, they have been told that the CCA is not the focus of health reformb "Wait."

The "Wait" to end unnecessary segregation of people with disabilities in institutions may soon turn into a "Never" for civil rights.

How hard is it to understand and accept that, but for the denial of civil rights, many institutionalized people with disabilities would live in the community with adequate programs and supports, especially since its cheaper for the federal government and states to provide such programs and supports in the community?

How hard would it be to enact a Disability Civil Rights Act in 2009 to end unnecessary segregation just as Congress did with the Civil Rights Acts in the 1960s?  A Disability Civil Rights Act in 2009 to end segregation could not be as inflammatory as enacting the Voting Rights Act of 1964.

Will U.S. Attorney General Holder look to how U.S. Attorney General Robert Kennedy addressed ending discrimination in the 1960s? General Holder could start by looking at the 313,000 people with disabilities living in nursing facilities who have said they do not want to be unnecessarily institutionalized.  He could inform states that Olmstead and the
ADA/504 require providing real choice for people with disabilities who are segregated and want to live in the community.

What do we have to do to create the atmosphere of the 1960s for the disability civil rights struggle in 2009?

Comment Below: How does our history compare to other civil rights movements? Latino? Women?...

Health Care Reform Bill Released

From Day In Washington (6/9/09):

Kennedy Health Reform Bill Released
By Day al-Mohomed

Yes, you heard it here first! Chairman Edward Kennedy and Democratic Members of the Senate Health, Education, Labor and Pensions (HELP) Committee just released their “Affordable Health Choices Act.”

Now it is important to note that considering the complexity of this legislation and how it will impact every single individual in this country, it will also require some Republican buy in. On Wednesday, June 10 and Thursday, June 11, Democrats and Republicans on the Committee will meet to discuss outstanding legislative options such as the public option and employer mandate.

Also, health reform isn’t just the HELP Committee’s issue. The Senate Finance Committee also shares jurisdiction, so Senator Max Baucus, Chairman of the Finance Committee, will play a large role in shaping the final legislation. A public hearing is scheduled for Thursday, June 11 at 3 p.m. and mark-up will begin Tuesday, June 16 which means we’re looking at a VERY fast-moving bill...

>>> For more including Day's Preliminary Analysis of the Bill

The Woodwork Myth

From Steve Gold (6/2/09):

The "Woodwork" Myth             

    For years, we have heard cries, fears and woes from elected officials about "the woodwork" effect.  No, these officials are not talking about cockroaches.  Then what do they mean?

    Under Medicaid, there is a federal statutory entitlement to institutional long-term services - people with disabilities have a statutory right to enter a nursing home or an intermediate care facility.  However, these same people with disabilities do not have a federal statutory right to receive the same long-term services in their homes and community.

    Why an institutional bias?  In part, it was a historical accident when Medicaid was enacted in the 1960s.  In part, Congress tinkered with addressing it by enacting "Waivers" in the 1980s.

    But then why doesn't Congress just amend Medicaid and eliminate the institutional bias?  One reason is nursing homes and other institutions have fed at the federal troughs for so long, made so much money, and politically contribute so much that they are now a political force. 
Keeping the status quo suits the nursing home industry just fine.

    Also, many elected congressional folks probably do not recognize or view discrimination against people with disabilities as a fundamental civil rights issue and violation.

    But that is not polite or pc to admit.  So instead, they invent a "woodwork" myth.

    Here's how it goes. If people in nursing homes were to have an entitlement to receive services in the community, then they would leave the nursing homes and live in the community.  The myth then posits that new people with disabilities - they're the people in the woodwork waiting and waiting - would then enter the nursing homes.  So the feds and states would have to pay for both persons who have left the nursing home and new persons who now go into the nursing home.

    The "woodwork" myth is premised on two fallacies.  One, people do not enter a nursing home because there are no available beds.  Two, people might enter a nursing home so that they could then leave the nursing home to receive services in the community.  Let's look at both fallacies.

    First, the "woodwork" myth would have validity only if the reason that people with disabilities do not enter nursing homes is because there are no available beds for them.  But that is not accurate or true.  For many years there has been a national vacancy rate of nursing home beds of about 13%.  Yes, even if no one moved out of a nursing homes, there are 13% beds empty.  These vacant beds could be filled immediately and are not dependent on anyone moving out. If there are people who want to move into a nursing home, they do not need to wait for people to move out.

    Therefore, the reason people do not enter nursing homes has NOTHING to do with whether people in the nursing homes leave or not, or whether there are beds available or not.  People could enter an institution as long as there are vacancies.  Their entitlement to institutional services has nothing to do with other people leaving these facilities.

    Second, it is really hard to imagine anyone would enter a nursing home solely or even primarily to gain eligibility for community-based services. 
Living in a nursing facility is not like a hotel!  Nursing facilities and ICFs are institutions with loss of privacy and other basic rights. 
Moreover, if this were a real reason for not eliminating the institutional bias, there are any number of ways to address and control it.  It's just an excuse to continue denying people with disabilities their civil rights.

    What compounds the issue is that the data clearly shows that it is much, much less expensive to provide services, on average, to people in the community instead of in institutions.  Providing Medicaid long-term services in the community to people in nursing facilities and other institutions will save substantial federal and state funds.

    So, next time you hear someone talking about the "woodwork" effect, tell them it's a myth.  Talk to them about civil rights of people with disabilities.

    Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. 
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

President Obama's Urges Health Care Reform, Neglects People with Disabilities

THE WHITE HOUSE

Office of the Press Secretary

______________________________________________
For Immediate Release               June 3, 2009

TEXT OF A LETTER FROM THE PRESIDENT TO
SENATOR EDWARD M. KENNEDY AND SENATOR MAX BAUCUS

June 2, 2009

The Honorable Edward M. Kennedy
The Honorable Max Baucus
United States Senate
Washington, D.C. 20510

Dear Senator Kennedy and Senator Baucus:

The meeting that we held today was very productive and I want to commend you for your leadership -- and the hard work your Committees are doing on health care reform, one of the most urgent and important challenges confronting us as a Nation.

In 2009, health care reform is not a luxury. It's a necessity we cannot defer. Soaring health care costs make our current course unsustainable. It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need. It is unsustainable for businesses, forcing more and more of them to choose between keeping their doors open or covering their workers. And the ever-increasing cost of Medicare and Medicaid are among the main drivers of enormous budget deficits that are threatening our economic future.

In short, the status quo is broken, and pouring money into a broken system only perpetuates its inefficiencies. Doing nothing would only put our entire health care system at risk. Without meaningful reform, one fifth of our economy is projected to be tied up in our health care system in 10 years; millions more Americans are expected to go without insurance; and outside of what they are receiving for health care, workers are projected to see their take-home pay actually fall over time.

We simply cannot afford to postpone health care reform any longer. This recognition has led an unprecedented coalition to emerge on behalf of reform -- hospitals, physicians, and health insurers, labor and business, Democrats and Republicans. These groups, adversaries in past efforts, are now standing as partners on the same side of this debate.

At this historic juncture, we share the goal of quality, affordable health care for all Americans. But I want to stress that reform cannot mean focusing on expanded coverage alone. Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach. So we must attack the root causes of the inflation in health care. That means promoting the best practices, not simply the most expensive. We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country. That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.

The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold. But for those who don't have such options, I agree that we should create a health insurance exchange -- a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.

I understand the Committees are moving towards a principle of shared responsibility -- making every American responsible for having health insurance coverage, and asking that employers share in the cost. I share the goal of ending lapses and gaps in coverage that make us less healthy and drive up everyone's costs, and I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it. In addition, while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted.

Health care reform must not add to our deficits over the next 10 years -- it must be at least deficit neutral and put America on a path to reducing its deficit over time. To fulfill this promise, I have set aside $635 billion in a health reserve fund as a down payment on reform. This reserve fund includes a number of proposals to cut spending by $309 billion over 10 years --reducing overpayments to Medicare Advantage private insurers; strengthening Medicare and Medicaid payment accuracy by cutting waste, fraud and abuse; improving care for Medicare patients after hospitalizations; and encouraging physicians to form "accountable care organizations" to improve the quality of care for Medicare patients. The reserve fund also includes a proposal to limit the tax rate at which high-income taxpayers can take itemized deductions to 28 percent, which, together with other steps to close loopholes, would raise $326 billion over 10 years.

I am committed to working with the Congress to fully offset the cost of health care reform by reducing Medicare and Medicaid spending by another $200 to $300 billion over the next 10 years, and by enacting appropriate proposals to generate additional revenues. These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.

To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC's recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.
These are some of the issues I look forward to discussing with you in greater detail in the weeks and months ahead. But this year, we must do more than discuss. We must act. The American people and America's future demand it.

I know that you have reached out to Republican colleagues, as I have, and that you have worked hard to reach a bipartisan consensus about many of these issues. I remain hopeful that many Republicans will join us in enacting this historic legislation that will lower health care costs for families, businesses, and governments, and improve the lives of millions of Americans. So, I appreciate your efforts, and look forward to working with you so that the Congress can complete health care reform by October.

Sincerely,

BARACK OBAMA

>>> From WhiteHouse.gov

ADAPT Seeks Presidential Recognition of Historic Olmstead Decision

ADAPT's Olmstead letter to President Obama:
 

The Honorable Barack Obama
President of the United States
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

June 22, 2009 is the 10th anniversary of the U.S. Supreme Court’s landmark Olmstead decision.  Disability and aging organizations all over the country will be recognizing this civil rights decision. [>>>For ways that you can organize a local event commemorating this history event]

The Olmstead decision, based on the integration mandate in the Americans with Disabilities Act (ADA) declared,  “unnecessary institutionalization amounts to segregation and is a violation of individual civil rights under the ADA.”  This case promised to be the national mandate not only to free tens of thousands of people with disabilities and older Americans from unnecessary and unjust institutionalization but also to avoid this type of institutionalization in the future.

The ADAPT Community has heard little from your Administration on how it will implement and enforce the Olmstead decision.  Under the previous Administration the implementation and oversight by the federal government had been sporadic and generally ineffective.  

The ADAPT Community believes that only with aggressive oversight and the development of accountability measures on how states are to implement the Olmstead decision, will people with disabilities and older Americans be able to stay or transition out of nursing homes and other institutions.  

Below are recommendations The ADAPT Community’s are making to your Administration for stronger Olmstead implementation and enforcement.  We would appreciate a response to these recommendations by June 15, 2009:

I.    President Obama should issue an Executive Order for an Intra-
       agency review as well as Inter-agency cooperation on policy
       changes that will implement and enforce the Olmstead decision
       with benchmarks and timetables for accountability.   
       HHS should be the lead agency.   
       President Bush issued an Executive Order
       soon after taking office to coordinate the federal governments
       response to the Olmstead decision.  Though initially producing
       some policy modifications, the overall results have been
       disappointing.  President Obama should use the current Executive
       Order as a model but give it more authority for real changes.       

http://www.whitehouse.gov/news/releases/2001/06/20010619.html

II. President Obama should direct the Secretary of Health and
     Human Services (HHS) to develop policies and accountability
     measures for how states must implement the Olmstead decision. 

III. President Obama should direct the HHS/Office of Civil Rights  
       (OCR) to be given more authority to make states more
       accountable for implementing the Olmstead
       decision with referrals to the Department of Justice for legal
       action when necessary.  HHS/OCR should accept and review
       individual as well as systemic complaints against a state. 
       Possible withholding of Medicaid payments to states for non-
       compliance should be made clear to all Governors and Medicaid
       Directors.  Results of all state reviews should be made public on
        the HHS website.

IV.  President Obama should direct the Secretary of Housing and
       Urban Development (HUD) to develop policies and programs that
        will facilitate the transition of people from nursing homes and
        other institutions to integrated community living. 

        ADAPT’s “Access Across America” should be looked at as one
        program to implement.

V.   President Obama should direct HHS to work with the National
      Governors Association, National Conference of State Legislators
      (NCSL) and advocacy stakeholders on Olmstead implementation
      best practices as well as the expectations of the his
      Administration for reforming the current institutionally 
       biased long term care system.

VI.  The Domestic Policy Council in coordination with the Secretary of
        HHS should convene quarterly meetings of  The ADAPT
       Community and other aging and disability advocate organizations
        to: 1)  get recommendations on policy changes that would get and
        keep people out of nursing homes and other institutions;
        2)  report on Administration’s progress in implementing the
        Olmstead decision.

Reform of the institutionally biased long term care system ultimately will require addressing the Medicaid entitlement that is currently only to nursing homes services.  That is why the Community Choice Act (CCA) should be included in your comprehensive reform of the health care system.  The anniversary of the Olmstead decision provides a timely opportunity for you to express your support for this legislation and the principle that people with disabilities and older Americans have a civil right to live in the most integrated setting. 

Including CCA in health care reform and aggressive Olmstead implementation and enforcement will assure that the growing number of people with disabilities and older Americans will have a real choice to live and receive services and supports in the community.  We hope to work with you to this end.

Looking forward to your positive response by June 15, 2009.

For an Institution Free America,

The ADAPT Community
1640A East 2nd Street
Austin, Texas 78702
adapt@adapt.org      www.adapt.org       512/442-0252