Bay Windows - National News, June 24, 1999
Loren King, Bay Windows staff

The Work Incentives Improvement Act of 1999 is being hailed as a major health care reform. Under current law, people on disability must choose between working and keeping Medicaid heath insurance. If they take jobs and earn any significant amount of money, they lose disability benefits and the insurance they get through Medicaid and Medicare.

"This is a big, important step for HIV/AIDS and other potentially disabling diseases," said Daniel Zingale of AIDS Action in Washington, D.C., which led a lobby effort for passage of the bill. "It was a long road to victory... We expect it to pass the House, and President Clinton and Vice President Gore have personally lobbied for it." Zingale said since more than half of all Americans with AIDS depend on Medicare, the bill represents a major step in offering them options.

Also known as the Kennedy/Jeffords bill for its main Senate sponsors, Zingale credited Sen. Ted Kennedy, D-Mass., for his leading role in the effort. "No single individual deserves more credit," Zingale said. "He personally was engaged in the lobbying process right up to the vote."

"No one in America should lose their medical coverage, which can mean the difference between life and deathùif they go to work, said Sen. Kennedy in statement. "No one in this country should have to chose between buying a decent meal and buying the medications they need. ... It's ridiculous that we punish disabled persons who dare to take a job by penalizing them financially, by taking away their health insurance lifeline, and by placing these unfair obstacles in their path."

Less than 0.5 percent of Americans receiving disability benefits ever return to work. Mostly, this is because they fear losing he health insurance, say advocates. The new legislation will affect about nine million adults who collect federal disability benefits.

The Work Incentives Improvement Act has other important components in addition to allowing the disabled to retain insurance benefits. It also establishes $305 million in funds for states to create their own programs for Medicaid expansion, said Robert Greenwald, director of public policy and legal affairs for Boston's AIDS Action Committee. States must apply for this money. There is now a bill in the Massachusetts Senate that would provide Medicaid insurance for poor HIV-positive people. At present, only people who are diagnosed with full-blown AIDS can collect disability benefits. That makes little sense to advocates like Greenwald.

"Early intervention is what works. But many people can't get drugs to rebuild their health until they are even sicker. That's ridiculous," he said. The federal grant money, if Massachusetts gets it, would pay for this expansion. If the state does not get the money to expand Medicaid coverage, said Greenwald, "we need to change the language in the law" that permits only those diagnosed with AIDS to collect disability and Medicaid insurance

Zingale agreed. "The Work Incentive Improvement Act designates new federal money for states to change the laws in order to cover people at the earliest stages of the disease. Now, people must have AIDS in order to get anti-AIDS drugs and treatment."

He said the bill also would apply to other progressive diseases, such as Parkinson's disease, by allowing persons to claim disability benefits at earlier stages that now allowed by law.

It was the financial aspect of the bill, which was first introduced in 1997, that kept it from coming to the Senate floor. Sen. Phil Gramm, R-Tex., blocked consideration last month because he claimed it would be funded by tax increases including a change in the foreign tax credit for some multinational corporations. At his insistence, Democrats agreed that the $800 million cost of he bill would be offset by cuts in spending elsewhere in the federal budget, not by a tax increase. The spending cuts will be identified later.

Rep. Barney Frank, D-Mass., told Bay Windows he doesn't expect problems with the bill in the House. It now has more than 200 co-sponsors and has been reported out of the House Commerce Committee. The next step for the bill is the House Ways and Means Committee before heading for a final vote.

"I'm optimistic. [Sen.] Gramm was holding the bill back in the Senate but that isn't likely to happen in the House," said Frank. "What the bill does is give those who are partly disabled the chance to work without losing medical care. The old thinking was that people are either totally disable or totally able. No, you can have a partial disability and it is inhumane not to let those people get medical care [if they work.]"
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