Statement of Martin H. Gerry November 18, 1987 Fourth, I believe that Congress should enact legislation extending the equal employment opportunity guarantees contained in Title VII of the Civil Rights Act of 1964 to physically and mentally disabled persons with the requirement that employers make reasonable accommodation to avoid the forced termination of disabled employees. Employer Tax Deductions or Credits Fifth, I believe that the appropriate committees of the Congress should explore changes in the Tax Code to establish tax deductions and/or credits to support the initial employment and continued employment of persons with developmental disabilities, including the costs of ongoing supported employment, job modification and restructuring, short-term declines in productivity, fringe benefits, facility and equipment modification, counseling and employee training. Passage of Medicaid Reform Legislation Sixth, I believe Congress should enact the Medicaid Home and Community Quality Services Act of 1987, or similar legislation, to allow States more flexibility to fund community and family support services for persons with severe disabilities who are living with their own families, in their own homes, or in community-based, integrated family-scale environments. Conclusion Mr. Chairman, I believe there is no need to separate out or differentiate social goals for persons with disabilities. In fact, because common social policy goals can be pursued by and for all citizens, the historical and ongoing mistreatment and injustice experienced by members of specific subgroups within American social, economic and political institutions can be shown in sharper focus. The consistent denial of justice to some within the American society Page 24 Statement of Martin H. Gerry November 18, 1987 denigrates and ultimately devalues the accomplishment of all others. In my view, the challenge for legislative action today is to achieve fairness in the pursuit of common social policy goals. Successful transition from adolescence to adulthood, from school to gainful employment, from convalescence back into the workforce, is a common and important goal for all of America's young persons and the effective coordination of planning and provision of habilitative, educational, vocational and support services to young persons with disabilities can dramatically improve the likelihood of successful transition from school to gainful employment of a large number of such young persons. I believe that Congress should take the six basic types of legislative action which I have outlined above to bring about the effective coordination of services to and opportunities for persons with severe disabilities. In my judgment, none of these actions will require a net increased in the current level of any Federal appropriations. While I am generally reluctant to suggest legislative changes as a solution to problems of program ineffectiveness, I am convinced that each of these changes is necessary in order to heed a first principle of moral and social philosophy applicable to legislation set forth by the contemporary legal philosopher John Rawls: "laws no matter how convenient or neatly arranged must be changed if they are unjust." Thank you, Mr. Chairman. I would be happy to respond to any questions which you or other members of the Subcommittee may wish to direct to me. Page 25 Mr. OWENS. Thank you. Mr. Kenneth Reeb. STATEMENT OF KENNETH REEB, JR., ASSISTANT DIRECTOR, REHABILITATION ENGINEERING CENTER, ELECTRONIC INDUS TRIES FOUNDATION Mr. REEB. Thank you. I wish to thank the subcommittee for its invitation for me to speak today on the topic of payment for rehabilitation equipment or rehabilitation technology by the Federal/State vocational rehabilitation system. By way of a brief introduction, I am the Assistant Director of the Electronic Industries Foundation Rehabilitation Engineering Center. Four and a half years ago the center was established under a cooperative agreement with what was then NIHR, which was redesignated through the reauthorization of the Rehab Act as the National Institute on Disability and Rehabilitation Research. The purpose of the Rehab Engineering Center is to conduct research aimed at stimulating private sector involvement in the manufacture, marketing and distribution of equipment, rehabilitation equipment for persons with disabilities. I would like to underscore that the ultimate goal of this center is of course to increase the availability of the types of equipment that we are starting to see emerge in the marketplace, designed for persons with disabilities. I think it is generally recognized that the commercial private sector is a very cost effective mechanism for developing and delivering useful equipment for persons with disabilities. Recognizing that commercial supply is motivated by conditions on the demand side of the marketplace, and also recognizing that market demand is predicated on the availability of payment sources for the types of equipment that we have been looking at, the Rehab Engineering Center has been studying, given considerable study the past few years to issues of payment for technology. The center has increase understanding of how persons with disabilities tend to pay for what is available on the marketplace. We have identified some serious difficulties that persons with disabilities encounter as they try to seek payment support for acquiring the type of equipment that is needed, and we are investigating what is being done or what might be done to address some of the serious payment problems as we see it. In my written testimony I describe the general process whereby the VR system pays for equipment for its clients, and I outline some of the problems that are inherent with that payment process. In the remaining time I would like to highlight one aspect of payment for technology that may become increasingly problematic for the VR system in the near future. The problem is first of all-and I think we have heard it from other testimony-the first aspect of the problem is that technology is by nature only a temporary solution, and secondly that, as we have heard today, the VR system as it is presently structured is not well-designed to deal with or handle what are considered temporary solutions. The VR system has traditionally been guided by the philosophy that holds that if you give someone a fish, you feed them for a day, but if you teach that person to fish, you help that person feed themselves for a lifetime. The general rehab process reflects that philosophy. Rehabilitation has traditionally placed emphasis on counseling, skills development, work adjustment, and other services that are all intended to teach clients valuable skills that presumably will serve them for a lifetime. Even the ultimate goal of the VR system, which is to attain what is called a successful case closure, using the term "closure" suggests this philosophy and this orientation within the VR system to provide a one-time intervention. I think my colleague on the panel talked about that orientation. Technology changes this orientation dramatically. Providing a client a piece of equipment may lead to a successful case closure today, but what happens down the road a few years from now when that person needs to replace that piece of equipment because it wears out, because it has become technically obsolete, or because they need a new piece of equipment for upward mobility in the work place? The reality is that equipment needs to be replaced periodically over time. It is not like teaching someone a skill. It only has a short-lived life cycle. Similarly, persons who rely upon equipment will need to periodically find ways to help pay for the replacement of equipment as replacement is required. What implications does this have for the VR system? In 1983 the Massachusetts Rehab Commission conducted a follow-up survey of over 100 former clients who had received vans and van modifications from the commission between 1977 and 1982. Part of the survey asked the respondents what their future plans were regarding replacement of the equipment that the commission had bought for them. Seventy-five percent of the respondents indicated having no plans for replacement of that equipment. In addition, another 15 percent indicated that their plans included going back to the Massachusetts Rehab Commission to seek payment for the next generation of equipment. Over time, it is probably safe to assume that as the need for replacement looms among a number of these individuals, that more and more of the people who had no plans will eventually end up turning back to the State VR agency for payment support. How might the VR system deal with this anticipated trend, this anticipated reinflux of supposedly successful case closures? One alternative is to promote financing rather than funding for VR clients to help pay for equipment. "Financing" and "funding" are terms that tend to be used interchangeably, but there is a significant difference between the two terms that needs to be clarified here. "Funding" generally refers to a payment arrangement for which little or no repayment is expected. Since a VR system has traditionally purchased goods and services for its clients, it is generally described as what would be called a funding service. "Financing," on the other hand, is a credit payment arrangement. Under financing arrangements, the end user of the piece of equipment is the person who is actually paying for that piece of equipment. Financing is simply a means to make that payment more affordable by stretching it out over a period of time. Financing is a payment arrangement that is more suited to paying for equipment. One of the reasons is that as individuals gain credit opportunities and demonstrate their ability to repay financial obligations, they begin to develop a sounder credit record. Subsequently credit becomes more readily available, making it then easier for the person to be able to pay for the next generation of product. VR clients and former VR clients seem to be an obvious group who could benefit from the greater access to product financing as opposed to funding. Presumably, because of their potential for competitive employment, they are or will be earning incomes that should enable them to be able to repay credit obligations over time. The question remains one of how might the VR system provide or encourage greater credit financing for its current clients and for former clients. I think it is somewhat premature at this time to prescribe any one universal approach, but it is an area that warrants continued attention. As noted in the written testimony, the Electronic Industries Foundation Rehab Engineering Center is currently studying the issue of product financing, and we are working with some private sector companies who are interested in implementing demonstration projects that will, for instance, that will set up loan guarantees where credit is made available for product acquisition. Similarly, as the written testimony points out, there are some financing projects that are beginning to be implemented under public auspices at State levels. California and New York are examples of State-organized programs that are trying to interject more credit opportunities for persons with disabilities. These should, as they develop, should generate some useful insights. In closing, I encourage the subcommittee to remain informed of these and other studies into the feasibility of encouraging and providing product financing for persons with disabilities. Financing seems to be one promising approach to improving payment for technology by the VR system for its current and former clients. Thank you. [The prepared statement of Kenneth Reeb, Jr. follows:] |