August 1990 Edition - Access Press by Access Press

Professional Sports Facilities in the

State Politicians

Volume 1, Number 3

- .eAugust 1990

and allowing deductions for all work related expenses. The Minnesota Medical Assistslnce law provided &at fmm the gross earned income of a recipient of medical assistancethe first $65.00 plus one half of the remaining gmss earned income would be disregarded. From the remaining income would be subtracted all work related expenses such as all State and Federal taxes, FICA, meals, employee paid insnrance premiu~ns,retirement umtributions, d o l k f directly related work expenses. Fobwing an of the Medical Assistance Program by the Federal Health and Human Services officials, the Minnesota Depmmnt d Human Services were informed that they were not in c m q h m e with Federal law. The Minnesota Department of Hrtman Services went to the Minnesota legislature and informedthem that the d i d Assi$3n~e$WG$f Minnesota needed to be changed * -,.

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The Americans with Disabilities was approved by the Senate July 13th, 1990. The Senate voted 91-6 in favor of the House-Senate conference report. It will now go to the President to be signed. President Bush said he was "delightednwith the bill's a p proval and will sign it. The Senators who voted against the bill (all Republicans) were Jesse Helms of North Carolina, Malcom Wallop of Wyoming, Jake Garn of Utah, Christopher

They could scrap the whole Department ot Rehab sew^,'' Mackey said.

.J*"

B o d of M~ssouri, Steve public accommodatians and pyromania. Symms of Idaho and Gordon Humphrey of New Hampshlre. The reasons for voting against the bill were rhe economlc burden placed on businesses, Increased law suits, and extending the coverage to people with AIDS. The bill is the most comprehensive antidiscrimination law to go into effect since the 1964 Civil Rights Act. The ADA will bat discrimhatio~ in transportstion, t e l ~ m m ~ o n

Passes; Fete Set Aug. 17 h . ,7*:-&'.!

for Minnesota to comply wifb the Federal law, rules nd* a% were related directly to their disability. Consequent regulations. )I, all State a d Federal taxes, FICA, meals, employee paid The Minnesota legislature amended the Minnesota Medi- insurance pmmbms, retirement contributions, and other cal Assistance laws in 1988. The amended laws provided directly related work expenses could no lager be deducted. that from one's gross earned income s h d be RUM "lhW-sota Department of Human M i ,on April 7, work expenses allowed by the Supplemad li%ui&y In- 1989 issued Medical Assistance Wnud letter #82 imcome program. The effective b d the t h e m t s was plementing these amendmeuts. February 1, 1989. The 1989M h e s ~ t legislature a amended one of the MedThese 1988amendmentsadopted the Supplemental Secu- ical Assistance laws again and repealed one of the sther lawg rity Income deductions and had the direct effect of eliminat- which they had Pkeady amended in the 1988legislative se& ing any deductions from earned income for employment- sion. The sole law setting. categorical eligibility requirerelated expenses for disabled individuals, unless those exSpenddown cont. on p. 8

employment. Within thirty (30) days The act defines a disabili- after enactment, all vehicles ty its a condition that "sub- purshased for public t r w stantially limits" a "major portation, railroad, and light life activity" such as walking rail will have to be .accessior seeing. It covers recover- ble to peqpEe with diwbiliing almholics, dmg users fies. In the next five-'y-d and for the 61% thepeople trains and subways in the with AIDS or people infect- U.S. will have to have at ed with the AIDS virus will least one car that is accessibe covered by federal l e g k - bb. Publicmass tramit syslation to p r o m them h m twm must provide altmiadisc-. Not covered tive transportation for those are other eznothd d i d - who are unable to board ers such as c e v e g a m - buses. . . sb h, g , klGptcmmh and DimbWy orgammtmns

from across Minnesota will join together on August 17, 3 6p.m. at theMinneapolis Convention Center to d e brate the passage of the Americans With D i d i t i w Act, a landmark civil rights di tfht "tfiiut- h& is expected to sign this summer. More than a 1,000 members representing every l d h & gdisability m ~ a tion in the stateare expected for this sensational event. Among the many featured guests attending will bt

=Ct*.

Dav~d ~chw&o~f, re? cently named the Disabled American of the Year; a d Sen. Dave Durenbeqa, a leading advocate of the ADA and disability rights. There will be displays of i n f ~ r m d ~from n bun* of orgad2atlons for the disabled. Spectacular pro refreshments and enten m - a t . Everyone is welcome

. '

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S- - T H '

By now the ADA (Americans with Disabilities Act) has been passed and signed by President Bush. It is time for all of us to celebrate! What is this going to do for me, you may be

reality. Things are going to change, and with the help of the new legislation, it will start changing soon.. The new law will force people to consider people with disabilities when they are plan-

We have gotten some good feedback from our last issue on transportation and I invite all of you to write and tell us what you think, good or bad. Mr. Ehrlichmann informs me that the Trip As-

have a problem. Help them improve the system by doing so. I would like to take this opportunity to introduce you to two new features in our paper. First is a new column

have to be accessible, including AMTRAK, the airlines and even the crosscountry bus. Buildings being built for public accommodation will have to be accessible i.e.: hotels, office building, apartments, res-

things will force individuaWdth disabilities as people who are contributing citizens of our society. So do take a minute to remember and thank all the people who made the

been that the service ran about 25 minutes later than the 112 hour window allowed (but I was not denied a ride). I hope Mr. Ehrlichmann is right and the expect-

the issue. See which of our current elected officials responded and how some candidates could approch the problems. Remember, we need to

. . . in the future. It will take time, a long time, before all of these things are a

byists, legislators, and everyone who took the time to care.

lays get shorter. The people at the Metro Mobility office are asking you to call if you

prove

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August 1990

Access Press

LEGAL AID:

ble, including fiscal sanctions. Here are a number of impor- the right to have the service continue at the same level as tant things to know about CSSAIrule 160: before the notice if you He your appeal prior to the effec1.The County CSSA plan must show how the county en- tive date of the notice. If you later lose the hearing, you do couraged citizen participation in the plan's development and not have to reimburse the county for these services. You how the county responded to concerns voiced by citizens. have a full 30 days to file an appeal, and the tirneline may The county must conduct a public hearing regarding the be extended to 90 days if there is a justified reason for delay. CSSA plan and must provide advance notice of the hearing. So what does all this mean if your chore hours are being (Hennepin County will be holding budget hearings at the reduced? Here's an example: Joan was receiving 10 hours end of August and September regarding the upcoming 1991 per month of chores services. She also is at the top of her portion of the current plan. This would be an excellent op- limit or cap regarding the number of PCA hours she portunity to put on community pressure for additional chore receives, and really needs those PCA hours for personal service funding, p m n u l d y since the county must provide needs. ~h~ county decided to reduce Joan's chore hours to some level of service to the 300 people it had planned to (to- 2 every 2 weeks according to a formula applied to everyone: tally) eliminate from services in the January, 1990, budget. 2 hours if one has a live-in PCA and an apartment, 2 112 if ~ ~ . ~ h e ~ o u n t y m u s t d o a n e e d ~ a s ~ e ~ ~ m e n t f onolive-inPCAandanapartment,3ifahouse(soundfdr~h2ar~et group (for example, "vulnerable adults"), including an as- iar?). The county did not discuss her needs with Joan or her sessment of unrnet needs. This assessment is supposed to be PCA provider agency prior to making its decision. Joan was the underlying basis for the budgeting process. If the assess- called by a worker from the county who told her what she . - H - ~-, ment is done inadequately or in error, the subsequent budget would now be getting. Then Joan got a "notice of action" levels may be vulnerable to review and revision. from the county reducing her services to 2 hours every 2 3. If the county plans to delete or reduce a service cur- weeks as of July 16. ciety will be writing a monthly column rently offered under the plan, it must amend the CSSA plan Joan filed a written appeal and request for a hearing on about health and government benefit programs, accessibility after having a 30-day notice and comment period open to the July 13, so her hours will stay at 10 until tpe DHS referee's and housing problems, and other issues that are of concern public. However, if the original CSSA plan contains a "con- decision is issued. This will take at least 2 or 3 months. Joan to you. In order to produce a column that is responsive, we tingency plan", the county may not have to go through an believes she has a good case because neither she nor her would welcome any correspondence regarding issues you amendment process. The contingency plan must specify PCA provider was involved in the development of her new would like us to address. Please send your correspondence how the county will prioritize and deliver CSSA services ISP giving her only 2 hours. She also did not get an adequate .o Legal Aid in care of ACCESS PRESS. when funds are insufficient to provide services to all appIi- assessment prior to the reduction in hours and can show that This month's column provides an overview of what you cants. If the contingency plan is not specific enough in how if her needs were properly assessed she would need more have a right to expect from the County under the Community it prior* W c e s , the reduction of services may not be than two hours. Her personal care attendant and chore ser- Social Services Act (CSSA). This is particularly relevant at in compliance with CSSA. vice helper will testify to this at the hearing. Also, because present because many of you recently had your chore ser4. If you are receiving services under CSSA,including her PCA program would bejeopardized if more hours were vices reduced to unacceptable levels. chore services, you have the right to an I m i h k h J Service added, she will argue that the lack of adequate chore mChore Services is one of the services which Hennepin Plan (ISP). This plan must be developed with* or your vices is interfering significantly with a County offers to residents under its 19W91 biennial CSGA representative and must be based on an assessmentof your highest possible level of independent living. plan. Chore Services is not a "mandatory" service which individual needs. The plan must state the specific services sidered, it is in Joan's best interest to go ak& with the Hemepin County is required to provide under state or feder- to be provided and must show how the services will "assist appeal. a1 law or regulations. This means that if the county decided the individual in attaining the highest level of independent Also, because Joan realizes that a h m services as an onto provide no chore services in its 1992-93 plan it could le- functioning appropriate to the individual." going option under the county is in trouble, she has gally do so, provided there was adequate citizen input into 5. If social services are denied, terminated, reduced, or decided that she will nty co-issioner and that decision. However, once the county has decided to offer you disagree with the level of services proposed or with your testify on the need for es at an upcoming public chore services, as it has in the current plan, it must do so ac- ISP, you have the right to an administrativeappeal before hearing on the budga rease funds available for -+ -+ -: cording to CSSA and its implementing regulations, com- a DHS appeals referee. The county must provide at least 10 chore services, monly referred to as "Rule 160". The Department of Human days written notice before taking adverse action. This notice If JoruP@9ae~y is familiar to you and you Services (DHS) has responsibility for oversight of every must be specific in telling you what thebasis for the county's cerns with a reduction in chore hours, vou may wish to con~Upty'splanand has several options if the plan is unaccepta- action is and must tell you how to 161e an appeal. You haw wt lpgal Aid Intake at 334-5970.

T he Community Social Services

A -

Opportunities G.-Dw They may be entry level they may be "menial", and they won't change your tax bracket, but jobs for persons with disabilities in the hospitality industry continue to open up, according to Dave Siegel, Communications Director for the Minnesota Restaurant, Hotel and Resort Associations. Siegel's associations represent some 1500 restaurant units, 650 resorts and 150 hotels, and the market potential they cumulatively represent is staggering. The foodservice business alone is the state's second largest employer, providing jobs for nearly 180,000 people. 60% of whom work in the greater Twin Cities area. 50,000 of these workers are seasonal, or will enter and leave the industry at least once in any given year - generally creating one employment opportunity each time they do. These opportunities are generally "back of the house" jobs - dishwashing, bussing, short order cook, cleaning. While the hospitality growing, business the traditional has been population providing workers to fill these jobs - teens - has been declining in number over the past several years, prompting employers to look at older worker..

es and members of the disabled community to fill recurring openings. The jobs offer a variety of benefits. Hours are usually flexible. Working environments are generally informa1 and relaxed. Sick pay, vacations and incentive raises are becoming more common as employers comPete for available human resources. And, perhaps most importantly, the hospitality industry is known to rely more on one's ability to do the job where promotions are concerned than one's educationa1 background. Promotions are generally made from within; in a high-turnover industry, each opening can create an opportunity for a reliable worker willing to listen, learn, show up on time and work the occasion-

a1 Depending on an individual's natural abilities and interests, promotions could lead to supervisory positions "back of the house", or front desk or other customer-contact position. Siegel suggests that those seeking employment phone or visit the hotel, motel, restaurant or resort of their choice, and inquire concerning job opportunities. If needs do not exist at the first facility, often a lead to another opportunity can be uncovered. The industry is growing. Experience with those with disabilities within the industry, according to Siegel, is almost uniformly positive. The combination could prove fruitful to those willing to make the effort.

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w.- -Guest Columnist

Access Press

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August1990

gAccess to Services: An Exercise in Absurdity? by Harold Kerner

Prior to 1961, services to persons challenged by mental retardation were minimal. Of those that did exist, little can be said for their the general public's conscience to the needs that were going unmet. In those days, educational services for people were limited to those who were identified as being 'educablen. The curriculum developed at the time had little to do with preparing them for their future. Generally speaking, special education teachers were at a loss for opportunities to acquire the necessary teaching skills to meet the needs of this population. Residential services in Ramsey and Hennepin counties as well as statewide were almost totally lacking. Minnesota was still very much in an institutional mode. Those leaving large state operated institutions traded their residence of 2000 beds to 150 bed places. The level of care improved somewhat, but still a custodial mind-set prevailed smaller "institutions". Sheltered workshop services limited their intake to those with mild to bor dation, who had good productive skills, and in general could work relatively independently. Persons transitioning from the special education programs in public schools had to meet strict entrance criteria, one of which was the ability to take public transportation. This factor alone eliminated many people because their earlier special education programs did not provide for mobility training. This was the environment of the early sixties - few services; poor future planning; little change from one residential setting to another; a continuum of services with many gaps. Yet, a wind of change however lacking in velocity was beginning to be felt on this environ.ment. In 1961, the Minnesota legislature, at the urging of the Association for Retarded Citizens and supported by the Department of Public Welfare (now known as Department of Human Services) passed the DAY TIME ACTIVITY CENTER ACT. This law allocated $25,000 through a grant-in-aid program which for the most part required matching local funds. Five counties responded and Day Time Activity Centers (DAC's) were on their way. To where, however, nobody really knew. In a broad sense they were viewed to be places of respite care for families of profoundly to moderately retarded persons. Many of these persons were scheduled to be placed in one of the state institutions. During the late 1960's and early 70's, people in the private sector were giving thought to the development of smaller residential facilities (15 or less beds). These persons conceived the notion of small, home-like environments in which people with mental retardation could live with dignity. At about the same time legislators recognizing the impact of the DAC's on the lives of families, and the changes that were occurring in the developmentally disabled as a result of DAC's, slowly increased the level of funding. At about the mid-70's, there began a shift in the amount of state funding to federal participation. In addition, the public school system began to provide educational services to severely retarded persons as a result of legislative mandate. One could easily say that life for severely retarded people was improving. Small group homes evolved (up to 8 beds), DAC's began to work more effectively in providing

meaningful functional training for the adult population. Indeed, progress was evident in the late 70's. There was much that still needed to be done, but families, advocates, etc., felt that at last a foot was in the door and there was light up ahead. A class action suit on behalf of those yet living in state institutions resulted in what eventually became known as the "Welsch Consent Decree." This led to a mass deinstitutionalization program that challenged community providers both at the residential and day program levels. As we moved into the Reagan era, social services of all types suffered tremendous assaults resulting in excessive funding shortfalls. Bureaucrats at all levels responded with severe cuts to budgets already lean. Despite pressures from advocates on all sides, public policy makers cowered, shrugging their shoulders and saying, "It's out of our hands, blame it on the feds." It always has been a struggle for adequate funding and most DAC programs resort to outside fund-raising projects in order to meet or enhance their meager budgets. In a number of cases, volunteer boards of directors were apathetic and left much of the burden of raising those precious "needed dollars" to staff members already burdened by day-to-day programming. Some administrators were confronted with indifferent bureaucrats on one 1 side and volunteer board members who wanted to take over the duties of the administrator on the other. Still other boards retreated from the awesome responsibilities of being in- .f w - d m l volved and active, especially at policy making levels which required decisions regarding over-all agency management. What exists at the present time is a service delivery system which is confounded by persons needing access to services and an inability to access the dollars that will provide them. It is only the creativity of conscientious program providers who try to make ten cents do the work of a dollar that keeps the system alive. It is ironic that, while the services con in whatever form they do, those who claim that there is more access to services no in positions of dictating how little they can get by with. Yes, access to servicesexists, in an absurd and financially deprived condition. There are those who still need to access services they are not receiving. There are providers stmggling to adequately serve the needs of those in programs. Politicians and bureaucrats in leadership roles, both state and county, must cease spending money on "trial balloons" which merely manipulatepayment plans. These are useless and fruitless attempts at making dollars stretch (dollars are not elastic). Such pilot proiects waste money and effort and benefit very few, while diverting attention from the ~eal"pmblem,lack o f commitment. What is called for now is the foresight and courage of the pioneer spirit in the 60's and 70's. Minnesota was in tKe forefront once. 1t canbe again: Let's make access to services less of an absurdity and more of a realizy.

'u -*

Harold Kemer retired in 1989 as Executive Director of Midway Training Services. He served a total of 28 years directing various DAC's in the

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m i Access Press

THE ACCESS

ISSUE UN1V ERSA L HEA LTH CARE

by Wm. A. Smith, Jr.

American health technology is the best in More sophisticated equipment, more mode rooms, more high priced medical specialists than any other country can supply. Yet the delivery system of this marvelous technology is seriously deficient. Millions of us have no health insurance, and millims more b v e ovexpiced or less than adequate wvera,ge. Costs of health care and health insurance have skyrocketed. Physicians pass on the cost of overpriced malpractice premiums or limit their practices to Safe" procedures. Individuals and hmilies m o t self insure against+: ble ruinous medical bills, and most rely on the& employers to select and subsidize medical insurance within their m a s . Employers must then hiring decisions based on limiting the cost of insuring their particular group. in business competition, t in a position to pay these

who are receiving assistance s must rely on federally funded Medicaid (called Medical Assistance in Minnesota). This program has many flaws, some of which are explored in detail elsewhere in this issue. Universal health care could remove a large pwt &the administrative nightmare faced by ~ with (or get off) the present assistance people h y h g live Prow. It appears that a comprehensive solution to these problerns is never seriously debated at the federal level, and states mainly use a bandaid approach to compensate for the big deficiencies. Some partial solutions are raised in Congress from time to time, but there is no d t m e n t toward

medical practioners as a group prefer the status quo. Private insurance and Tee for services" are the American Way, in their view. It's huethat in Minnesota we are fortunate in having a large number of physicians who accept salaried positions with health maintenance organizations, but HMO premiums also have escalated out of reach of most individuals ability to pay, as have the conventional insurance plans. Insurance companies are big beneficiaries in this system, and naturally have no reason to lobby for change. In a comparison of the costs of health care with the Canadian system, the U. S. system spends almost three times as much on administrative costs. Most of this money goes to insurance companies, as premium income and as fee income for administering government plans and those of self insuring larger employers. The Canadian system which was used as a basis for one of our questionsto our legislators is not a perfect system. It was chosen because 56 % of their citizens felt it was working "pretty well" in the same Harris poll which indicated 89%of U. S. citizens felt our system needed fundamental improvement. We recognize that Canadians may have different cultural values, and may have to wait for some services considered non-threatening there, which would be provided on demand in the U.S.Also, we do not feel that their system's retention of "fees for service" provides the basis for the best medical service. Nevertheless, they have a system in place which covers everyone, they spend less per capita and most people like it. It is certainly worthy of discussion by our legislators if they are going to attack the problem in this country.

CONGRESSMAN JAMES OBERSTAR Recent debate and the repeal of the CaWstmpMic Health Insurance Act has focused altentbn on the need for a comprehensive national health care system. My preferencecontinue&to be a national health plan, open to all, in which the government, the employer, and the beneficiaty share thecosts. Given the

h r a national 'health care system. to outline broad policy 1. Isincerely hope that a national health care system can be implemented in * the next ten vears. Because the state of Minnesota has c o n s i s t e i i * r m ~ -

HE ANSWERS.

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criminated against on the basis of ability to pay, age, or illhe*. RP add% tion, Canada spends less for health care asa percentageof 6Nf than the United Statgs. Iam,however, concerned with some aspects of the Canadian health care system. There have been a number of reports that some Canadian citizens in heatth coverage have had to weit for medicel servFc881, and-dmhys could be viewed as a denial of care. While it is clear that our current health cam slpstem is in need of repair, and that a national health plan is the p r e ferred metbodof healthcare coverage, 1am not sure that the American peaple are preparedto accept a number d fundamental chanaes in the manner aur h.eelth care is delivered, and am nut convinced that GRshould carbonthe hnedian system

SENATOR RUDY BOSCHWITZ (No response) CONGRESSMAN GERRY SlKORSKl

SENATOR DAVID DURENBER (NO W o n - )

CONGRESSMAN BILL FRE Office staff says 'Not camp Declined to answer

CONGRESSMAN TIM PENNY (No response) i

CONGRESSMAN ARLAN STANGELAND (No response)

3?.~,000Americans 1 in every 8 have no health coverage at all. Threetaurths am workers and their dependents, and onethird are children. Over 1 millionAmerbans were denied health cars in 1989 because of inabiw t~ pay; an ~&tnated14 million people dM not even seek necessary treatment because of cost. This is wrong and unacceptable and the Health and Environment Subcommittee, on which I serve, is currently reviewing several proposalsthat will work to ensure that at least all working Americans will have access to health insurance cawage. 1. With the Bush Adminbtration in ~ B ~ Q It Dk , unliity that there will be an across-the-board solution to this probtm. FWIW,fhe current system wit1 probably be tinkered wi4h with some Medicaid and M m axpasions in populations sewed and services covered. The Pepper Cb-s m cent recommendations,which are now being carefully reviewed, endorsed utiiizing existing sources of insurance (a multi-payor system based on the ampamtiin of the public and private sectors). We can learn mwb from the Cartadian approaches, and adapt to meet our m 2 . - own needsthe strategies that have allowed them to provide universal access to care*

.. :

CONGRESSMAN VIN WEBER (No response) CONGRESSMAN MARTIN SABO GUBERNATORIAL CANDIDATE JON GRUNDSETH

Ibeliq&@mWbmdtragedy that 37 million Americans do not have health ineurance of any kind and mDllions more lack adequate covergge. We must make it a top naMonal prior#y to repair the deficiencies in a system that lets so many people slip through the cracks. That is why Ihave introduced legislation every two years since 1979 that would guaranteethat all Americans have accaag to comprehensive heakh insurance. help low-income people pay for piwerage. and provide catastrophic protection for all citizens. f. WbetheF we will be able to adopt a comprehensive solutiin to this critical problem Whin the next decade is uncertain. But that should certainly be our goat. the meantime, however, we shouldstart taking the steps that will lead us in that dmcth. The problem is simply too serious to ignore. 2. The Canadian h m l h care system is one model that deserves serious examination. It is unclear, however, whsahar itGIM betransplantedin the Unik

Access Press

Augvstl990

1990 'AL INQUIRYIAUGUST J THE I.~population a n covered E 0 0in the 0 !UESTIONS: years? I Charles F. Smithmtx.

;

" " + . I &

of the / 0 10 next

2. Do you think the Canadian program (offering nationwide coverage to all citizens for hospital & physicians costs with free choice of physicians) is a good solution? I7-q

3. Why? SENATORIAL CANDIDATE PAWL WELWONE

GUBERNATORIAL CANDIDATE MIKE HATCH

.Affordable health care States -the only major system must examine

Mike Hatch, has pledged to make healthoem h itop priority as governor and isthe first candidateto propose aggressive steps to reform the health care crisis in Minnesota. Hatch's goal is to make health care accessible and affordable for all Minnesotans. 1. Yes. The first item on my agendacome January, 1991is to make health care accessible and affordable for all Minnesotans. My administration will rene of many good solutians.

lists

e premise of my proposal is that the cost of health coverage for the small tilploy~~0~11Wthrrt-rt-h resulted as in employment dmmination against the physically disabled and middle aged, resu flow of Wnnesotans 'Mo the uninsured pqwktkm. Ther-, I lower costs. The employers would then

a (MCHA), an insurance pool for those declined cawrage intheprivatemetar. Atso, indkiwho reach the lifetimemaximum d their insurance-should be dlowedto be immedicowred in the MCHA program.

SENATORIAL CANDIDATE JIM NICHOLS As the parent of a handiqapped child Ibelieve that all Americans are entitled to adequate health care. That includesthe 37 million Amerkatw end 400,000 Minnesotans wha are not now covered by a health insurance program. Throughout this campaign, Ihave advocated a National HealthCare program that would require all employers to provide health insurance. Small business costs of this program would be reducedby putting all high risk employhSYn6a a fmtional pool that would receive $23 billion in federal funds to redrcsx9sosts. This national pool would include a pubric plan that allowe swgone not employed to purchase low cost health insurance. The result of this program would be that every American would be covered by health insurance through their employer or through the public plan. Medical care costs would be reduced by capping benefits available for malpractice lawsuits and using the Canadian modelthat requiresmalpractice lawsuitsto be heard by a judge and

-MESSMAN

4s a member of Congress, I have long favored providing universal access to iealth care coverage for all Americans. Iam Eosponsoring the Compreheniive HealthCare ImprovementAct. which would requirebusinesses to provide :omprehensive heelth insurance to employees. Ihave supported other mealures such as the US Health Act and the Long-Term Home Care Catastrophic ProtectionAct. Since the dramatic changes Isupport such a$ universal health cere ate not likely to occur this year, Iam supporting incremental changes in health care policy to improve the health care system for all Americans. These bills include expanding Medicare benefits, d i prevention efforts,greater eligibility for Medicaid. increased fundkg C fesearch and tougher regulations and enforcement of occupational health standards. 1. I am a strong supporter of national health care and think it would be reasonableto predict that a national health plan could be fully in place within ten years. 2.1 support the basic objective of the Canadian program comprehensive national health care for all. Our American health care system is complex and a national health care plan may not be simply transplantedfrom one nation to another. Our nation has its own unique needs and problems and a health plan must be tailored to address these circumstances. 3. The strengths of the Canadian modelshould be reviewedas we are crafting a comprehensive universal health care system. I supported the Medicare P M C legislation offered by the late Congressman Claude Pepper which was essentially based on the Canadian model. We can certainly learn valuable lessons from the Canadian model and other innovativeapproaches to health care. As public support for national health care builds, the urgency of this issue is growing within Congress and the Administration.

1. The healtlr care w y opposes nationalhealth insuranceand have publkly

stated that we will see national health care as long as a Republisaaoccupies the White House. 2. The Canadian program for health care is superior to U.S. healfh care because the Canadians spend 8 percent of GNP for health care instead of 11 percent spent in the U.S. for health care.

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GUBERNATORIAL CANDIDATE ARNlE CARSON 1. The corne tion: Its ta neecotens. ing with health care and social issue@fbe high cost of critical care and imprisonment. 2. The Canadian program demonstrates the fe&bMy of 'x care for an through a government program financed by tbn. Though decentralized, it is fund8menWy a Pgdeml used as a model, along with the CommrmHeaIlhplanfrom â&#x201A;Źhastate of Mae adapting the system to meet the needs of Mlnnesotmer in all sectors. Our RFst pr#m&, ttmgh, in line with om emphasis on prevention of p r s b h s , wUI be to kt@ familk lndYh 3. Today, in Minnesote, the Chfldren's Health Plan has been eatablishd to care for the children of the working uninsured. It is a unique &xmgm& @M only one of its kind in the n w n . The plan ncmr GOUBFB only WMm grid preventative&#h: ewe.T b major drawback of Wis p!& b#@ Idoes net cover critDcal care: s-rs to the program, both rural and . It is a program that is established and workmetro, are extreme ing here inthestate andcouldbewved as W s for expandingto thegeneml uninsured population.

BRUCE VENT0

WYT

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~ " COMMENT: S We're happy to have received these thoughtful responses to our questions. It is gratifying to seethat a number of influential incumbeats and candidates have recognized the need for universal h e w care in this country. Next month we'll have the results of our inquiry on another very tough issue-HOUSING. Please see Page 4 for the new questions. '-

a -

ervices: An Exercise in Absurdity?

by Harold Kerner by mental retardation were minimal. Of meaningful functrair@ng&-b &ult population. Indeed, progress was evide..& bte ?Ws. There was much W-siiill n&ded to be done, but families, advocates, etc ic's confelt that at last a foot was in the door and there was light up ahead. A class action suit o behalf of those yet living in state institutions resulted in what eventually became h o w ly retarded young people were limited to as the "Welsch Consent Decree." This led to a m s deinstitutionalization program that curriculum developed at the time had enerally speaking, special education challenged community providers both at the residential and day program levels. a loss for opportunities to acquire the necessary teaching skills to meet As we moved into the Reagan era, social services of all types suffered tremendous assaults resulting in excessive funding shortfalls. Bureaucrats at all levels responded with severe cuts to budgets already lean. Despite pressures from advocates on all sides, public ices in Ramsey and Hennepin counties as well as statewide were almost nnesota was still very much in an institutional mode. Those leaving policy dcm cowered, shrugging their shoulders adsaying, "It's outaf w r hands, blame institutions traded their residence of 2000 beds to 150 it on the feds."

'?Sheltered workshop services limited their intake t& those with mild to bo

of Public Welfare (now known as Department ACTIVITY CENTER ACT. This law docated $25,000 through a grant-in-aid prdgram which for the most part req&ed matching local funds. Five counties responded and Day Time Activity Centers (DAC's) were on their way. To where, however, nobody really knew. In a broad sense they were viewed to bi places of respite care for families of profoundly to moderately retarded persons. Many of these persons were scheduled to be placed in one of the state institutions. During the late 1960's and early 70's, people in the private sector were giving thought to the development of smaller residential facilities (15 or less beds). These persons conceived the notion of small, home-like environments in which people with mental retardation could live with dignity. At about the same time legislators recognizing the impact of the DAC's on the lives of families, and the changes that were occumng in the developmentally disabled as a result of DAC's, slowly increased the level of funding. At about the mid-70's, there began a shift in the amount of state funding to federal participation. In addition, the public school system began to provide educational services to severely retarded persons as a result of legislative msndate. One could easily say that life for severely r d e d peqle was improving. Small group . homa evolved (up to 8 be&), DAC's began to work more effdvely in providing

the work of a dollar that keeps the system alive. It is ironic that, while the services continue in whatever form they do, those who claim that there is more access to services now sit in positions of dictating how little they can get by with. Yes, access to s e ~ p i s t sbut , in an absurd and financially deprived condition. need to access services they are not receiv~ng.There are ly serve the needs of those in programs. Politicians and ,both state and county, must cease spending money QILW ' balloons" which merely manipulate payment plans. The at making dollars stretch (dollars are not elastic). Such pilot proj effort and benefit very few, while diverting attention from the real mitment. What is called for now is the foresight and courage of the in the 60's and 70's. Minnesota was in the forefront 09. to services less of an absurdiry and more of a mz@t. Harold Kemer retired in 1989 as Enecdm Director semed a total of 28 years directing W'ious DACk in

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A ~ p s r1990

r Press

'Getting Aroundy No Problem at ThisYear's State Fair Wheelchair rental, curb cuts, low-mount telephones, sign language interpretation during Grandstand performances and accessible parkp, restrooms and seating for Grandstand and Coliseum events are among the provisions offered for persons with disabilities at the 1990 Minnesota State Fair. In addition, there are special drop-off points on the fairgrounds for disabled fair visitors who travel to the fair with Metro Mobility, public camers or private transport and a special satellite parking lot with wheelchair accessible shuttle service to the fairgrounds. Wheelchairs are available for rent at the St. Paul Pioneer Press Care and Assistance Center, located on Commonwealth Avenue under the Grandstand ramp. Rental fee is $1 per hour with a refundable deposit of $20 and a drivers license or appropriate identification. A 'irnited number are avail~ b l e so , it is advised that arrangements be made in advance. Curb cuts are located everywhere on the fairgrounds to aid wheelchair travel. Low-mount telephones can also be found throughout the fairgrounds. Considerations for persons who are hearing impaired include a TDD telephone, available for free public use at the Access Minnesota Information Booth on Randall Avenue between Underwood and Cooper Streets. Also, all Grandstand performances will be sign-language interpreted. Special seating information is available by calling (612) 642-2262; TDD (612) 642-2442. Various types of accessible restrooms can be found throughout the fairgrounds. Unisex restrooms are available under the Grandstand ramp and at the Medical Aid Building. Wheelchair accessible restrooms are located at Machinery Hill, the Arts Center, Heritage Square,

the Service Building, the DNR Building, under the Grandstand Ramp and in the Coliseum. Restrooms with grab bars only are located on the second floor of the Grandstand, on Nelson Street between Judson and Carnes, at two locations along Cooper Street and at Empire Commons. In the Grandstand and Coliseum, a limited number of reserved seats accessible to disabled persons are available. It is recommended that tickets for these seats be purchased in advance. ~ e n e r aadmission l seating is also available on a firstcome basis. Grandstand seating areas are on the promenade; in the Coliseum, accessible seating areas are inside the entrances to the seating area. Persons requesting accessible seating may purchase a ticket for one companion to sit with them in both the Grandstand and Coliseum. Curb parking for persons with disabilities is available at 18 locations near the &st Commonwealth gate, 68 locations on the north and south sides of Commonwealth Avenue near the West Commonwealth gate and 17 locationsjust north of the Arts Center. When unmarked accessible parking spaces are available in regular fairgrounds lots, people are directed to these spaces. All parking is filled on a first-arrived basis. Vehicles whose drivers or passengers utilize identified parking facilities for disabled persons must display a valid handicapped parking permit. Fair visitors who are disabled or elderly and unable to ride regular route buses may be eligible for door-todoor trans&rtation through Metro Mobility. The Metro Mobility service uses a variety of transportation providers, ranging from local taxi companies to providers using loft or ramp-equipped vehicles to transport qualified persons within the

politan area. For more information on Metro Mobility, phone (612) 349-7480. A satellite parking lot with wheelchair accessible shuttle service to the fairgrounds is available at Builder's Square, located south of the fairgrounds on Energy Park Drive just west of Snelling Avenue. The drop-off point on the fairgrounds is the Access Minnesota Information Booth on Randall Avenue. The shuttle runs from 8 a.m. to 10 p.m. throughout the fair and costs 50 cents each way. The shuttle leaves the Builder's Square lot every hour on the hour and the Access Minnesota Information Booth every hour on the half hour. Metro Mobility Metro Mobility, other handicapped carriers and identified taxis and vans should enter the fairgrounds at the North Underwood gate, drop off passengers on Randall Avenue just east of U n & m d @ t *I+ cess Minnesota and exlt out the North Underwood gate. Drivers will not be charged unless they plan to stay on the grounds. Passengers will be charged the usual entry fees. Vehicles may not be parked on Randall Avenue as it is a drop-off point only. Pick up is at the same location using the same route. Another drop-off point where fair visitors with disabled passengers can drop passengers off before parking is located on Commonwealth Avenue and Liggett Street near the west end of the Grandstand. It is recommended that persons using this drop-off point enter the fairgrounds at the West Commonwealth gate. For more information on fairground facilities for persons with disabilities, or to receive a map of accessible facilities on the fairgrounds, call (612) 642-2248; or write, Minnesota State Fair, St. Paul, MN 55108.

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Access Rgader Profile

PROFILE: Steve Alarik I PERSONAL AGE: 40

BACKGROUND: Edina High School; U of MIJournalism; Brown Institute1Broadcast Journalism; ABC Television affiliates here and Green Bay; Own show in Green Bay; Politics beginning in early 70's on campaign staff of HHH challenger Earl Craig; MR/MI/Group Home counselor; Artistic Director, Coffee House Extempore'; pa: time at Legal Aid; Leather artist DISABILITY: Paraplegia WHEN: Age -5

--:

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P O S T - T R A ~ O U T L O O KAccepting : CURRENT OUTLOOK: Same, refined by experience, enthusiasm, intellectual curiosity. Positive, helpful, bright sense of humor. Aware of no distinction between self and able-bodied friends except speed of travel. He is much faster. OCCUPATION: Rehab Technician, Abbot Northwestern HospitalISister Kenny Institute. RESPONSIBILlTIESlREWARDS: Fixes, fits, modifies &/or adapts in-house "fleet" of 250 wheelchairs. Walked on "sticks" until four years ago. Learned on own donated chair, and those of friends. Was born at Abbott, went through Kenny Institute. Volunteered for technician duties; now expanded to half-time position. 80% basic maintenancelrepair - fit, wheels, brakes, etc. 20% most satisfying - working with nurses and therapists to adapt chairs to individual patient's needs. "It's like giving them wings". LEISURE TIME ACTIVITIES: Time, leisure funding both in limited supply. Mostly home-based. Reading, leatherwork. Currently reading Sister Kenny's autobiography. FeFAMILY: Single. Dates occasionally, with someone who "eats cheapw. GOALS: This. I've found my niche. I can work with my h d s , and still employ enormous amounts of creativity. I can use my mind. I'l never know all there is to know, and I'll never catch up. I consider myself very lucky. You ought to see the faces. This is my career".

complete legal services

August 1990

Access Press

Pro S ~ t Accessi s bilitygig League.": by Adam (&inn

thantheowner,l , sublessee of a building or their employees9 facility, some of the major requirements include: * Site approaches not less than 48 inches wide, of permanent material with slip resistant surface, and a s l o p not greater than 1:20.1

Ever since names like George Mikan and Harman Killebrew began gracing the pages of the local press, the Twin Cities have been mown as major league when it came to servhg up profe~~siod sports events. Until they invent more sports, the Timbenvolves will largely close theloopon

days of particularly cornpetitive 1-1 contests. For , persons with mobility-related disabilities, the sighs announce a different kind of relief. Wi a I&. and professbnutl venues are almost universally accessible, and continue to o R r a wide choice of viewing options for those ~r whom TV is no substirue for the sights, sounds, and on-site excitement of -being there" in the flesh, Though the wheelchairbound can take accessibility to virtually any new publik facility for granted the fixture was not always offered, and is not without financial administrative cost. Older facilities must upsighs d&&g &= be grade to meet evolving stanleagured fans whoGe NR out d M s , and all of ailing aunts to Pewd rn the 13' r ~ p o n ~ b l -

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up with bod~ trends and changes in existing codes. handicapped-accessible Chapter 1340of the State d .&e floor of access by id r m p or elevator. If ramp, 500 additional. - - -. the slipresistant surface , must include a landing at top ro- and bottom, and a slope no &me., Met Center, St. Paul greater than 1:12. Civic Center, Williams1 * At least one 12'-wide Mariucci Arena, Canter- iicmdble parking space for bury Downs new every fifty spaces or fkaction T i m w v a thereof. Fw designing * Doors with a clear Wuse anex- opening width of no less general pub- than 31", operable by a sin& (". . persons other gle effort with one hand.

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PRESS expressed conom for the needs of the mobilityimpaired customer, and a willingness to modify existing facility lay&, if necesssay, to facilitate the customer's convenience and viewing oppottunity. WOEmation concerning lscal facilities and contact person-

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Durenberger Proposal

Legislation Would Restore Medicaid Eli~:3ili Legislation introduced in mid-July by U.S. Senator Dave Durenberger could restore Medicaid eligibility for several hundred Minnesota residents adversely affected by regulations developed by the federal agency responsible for Medicaid. Durenberger's legislation, S.2843, restores flexibility for states like Minnesota to disregard income and Social Security taxes and other appropriate expenses when income eligibility for Medicaid. S.2843 was referred to the Senate Finance on which Durenberger serves. Durmberger is the ranking minority member on the Senate D i s a U i Subcommittee. According to Durenberger, the federal agency that administers Medicaid has tried, since 1982, to prohibit states from being more liberal than certain federal standards in subtracting income and Social Security taxes in determining income eligibility for Medicaid. "But Congress passed legislation in 1984, 1987, and 1988," Durenberger said, Wodarify its intent that these more liberal inwnwdirmgards be allowed." For man3 disabled people, Durenberger said, health care axpenses are so high that a rigid tie between Medicaid eligibility and income doesn't make sense. "There are strong disincentives to work and earn income," he noted. "But, that's not just theoretical economics," Durenberger

Lx .

. 4

told a June 4th Minneapolis press collwce where he announced the legislation. 'For hundreds of disabled Mimesotans, it's threatening their indepkndence and robbing their assets." Durenberger's June 4 press conference was attended by a number of representatives of the Minnesota disability community, as well as Legal Aid and state government officials, luding Minnesota Human Services Commissioner Ann of those who spoke at the press c o n f w was Leah Welch, a quadriplegic who heads a non-profit agency that assists others with disabilities. Until last year, Welch was being substantially assisted in her medical expenses by Medicaid. But, after federal officials told Minnesota it could no longer deduct income and Social Security taxes from her income, Welch's personal outlay for medical increases increased by $1,000 per month. "That's not the way we do things here in Minnesota," Durenberger said at the press conference. "It's wrong. It's not what Congress intended. And, it's not going to happen once we get the rest of my colleagues behind this legislation." According to Durenberger, approximately 200 Minnesotans fall in inwme categories that would benefit from this legislation. The total estimated cost to the federal govern-

+ --

ment of the bill would be about $300,000 for Minnesota and I about $10 million nationally. Medicaid eligible individuals :" -. in about 36 states would be affected by the legislation, .: d5-, Durenberger said. "$10.0 million is a small price to pay for the added dignity and independence that comes from work," Durenberger said. "We should be encouraging - not discouraging - people to become more independent by earning income. This legislation can help accomplish that goal for thousands of people in Minnesota and all across the country." Durenberger said he is currently seeking co-sponsors far his legislation and hopes to attach it to a comprehensive health care or budget bill later this fall. Among those Senators who have already agreed to co-sponsor the legislation are Sen. Pete Wilson (R-Calif.) and Sen. James Jeffords (R-h Vermont). pXP' = Minnesotans who support the Durenberger's legis~~fibk -2 are encouraged to write to other members of the Minn Congressional delegation to urge their support, as well. For more information on this or other disability bills now pending in the U.S. Congress, contact Senator Durenberger's office at 1020 Plymouth Building, Minneapolis, MN 55402; 612-370-3382; 800-752-4225 (toll free in Minmnesota). e

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