Session I of WID’s Center on Economic Growth policy summit on employment and disability benefits began with opening remarks from Andrew Imparato, Senior Counsel and Disability Policy Director with the U.S. Senate Committee on Health, Education, Labor and Pensions, addressing Senator Tom Harkin’s goals for employment of people with disabilities.

Andy Imparato began by setting the stage for the summit by characterizing Senator Harkin’s commitment to employment of people with disabilities by addressing the Senator issues addressed in his April in speech to the U. S. Chamber of Commerce where he stated that the number of people with disabilities in the labor force had dropped from 5.7 million in September, 2008 to 4.9 million in September, 2011. For every one non-disabled person who lost a job in the past three years, nearly two people with disabilities became unemployed.

He said that Senator Harkin challenges government and business to increase the number of people with disabilities who are employed to 6 million by 2015, and to do that, everyone needs to talk about it, focus on it and demand it.

Senator Harkin is the Chair of the Committee on Health Labor and Pensions and Chair of the Subcommittee that funds the Department of Health Labor and Human Service, and the Social Security Administration, which is a unique double role. And he has about 100 people working for him. He now has 4 professional staff that does nothing but disability policy, which is pretty unheard of.

Senator Harkin has held five hearings so far on issues related to disability and employment including one at Gallaudet University where all those providing testimony were deaf or hearing impaired.

On a percentage basis, the percent decrease in the labor force for people without disabilities was less than 1/3rd of 1 percent while the percent for people with disabilities in the labor force decreased by 14% - people with disabilities had been leaving the labor force in the last 3 years at a rate 10 times the rate of people without disabilities.

Senator Harkin issued his challenge of 6 million jobs for people with disabilities by 2015 based on the President’s Executive Order, announced on the twentieth anniversary of the ADA, to hire 100,000 people with disabilities in the federal government by 2015. Harkin believes that if the federal government can employ 100,000 workers with disabilities by 2015 then the country at large can create one million additional jobs for people with disabilities by 2015.

Anita Aaron, WID Executive Director/CEO, said that this session of the Center on Economic Growth was convened as part three of meetings that began in September 2010 when Senator Harkin held a summit to discuss the employment situation for people with disabilities. Those meetings were followed by a summit co-hosted by WID, Mathematica and NCIL in April focusing on disability benefits and their relationship to employment. Outcomes of those two meetings as well as from these current discussions will be distributed to all in attendance and posted on WID’s website.

Neil Jacobson and Patrick Gaston were introduced to talk about the Center on Economic Growth and the Center’s goals.

Patrick Gaston thanked Neil Jacobson for his leadership in the development of the Center on Economic Growth and read opening remarks prepared by Neil.

Thank you for being here. We have very high expectations for this Summit. We believe that now is the time to change the paradigm of how we think about economic growth for people with disabilities. As entitlements continue to be questioned and their funding becomes more tenuous, we must embrace the belief and create the reality that people with disabilities are equal members in our society and full economic partners. We must change our mindset from providing disability benefits and safety-nets to providing what it takes to enable people to successfully fulfill their role in the economic growth of themselves, their family and their extended community.

Economic success for people with disabilities should be defined exactly the same way it is for everyone. Economic success is taking full advantage of opportunities one can find or create that uses ones abilities to be as productive as one can be and as prosperous as one wants to be. WID believes the return on investment of this paradigm shift is both significant and measurable.

We are going to begin the Summit by reviewing recommendations made by the World Institute on Disability, Mathematica Policy Research and the National Council on Independent Living. Like all recommendations, these were made using certain mindsets. These mindsets include notions such as a safety net is needed for people with disabilities. Another paradigm is that employers should and will hire people with disabilities if they are equally as qualified as their peers. A third paradigm is that people with disabilities need rehabilitation to learn how to perform existing jobs. What if we change these paradigms? What if disability benefits were seen as equalization benefits – a way of leveling the field and removing the cost of disability as a barrier? What if, instead of safety nets, we provide civil service opportunities and expect people with disabilities to earn their way just like everyone else? What if rehabilitation was seen as a way of discovering how people with disabilities can be productive and prepared for tomorrow’s jobs, challenges and opportunities?

The Disability Movement has historically been about changing paradigms. Growing up in the 50’s and 60’s, the predominant paradigm regarding disability was that people with disabilities had to adjust to their environment. Our goal was to look and sound and act as ‘normal’ as possible. It wasn’t until the paradigm changed and we realized that society should be accessible to all people that true progress began to occur. Surprisingly, the predominant paradigm with regards to employment of people with disabilities has not changed. We still hear ‘hire people with disabilities’ and ‘people with disabilities can work.’ In this global economy, when employers know they can hire very qualified and experienced people anywhere in the world, expecting them to hire people with disabilities will only get harder. As a retired senior vice president of Wells Fargo Bank, hearing that ‘people with disabilities can work’ is demeaning and patronizing. I submit to you that the crux of the problem behind the employment of people with disabilities lies in these antiquated constructs. I submit to you that the paradigm for the 21st century should be that everyone must be productive. Now is the time to raise expectations, to determine how we will be productive, and determine how we will create our own prosperity.

As you listen to the recommendations Bryon and David are going to review with you, please think about the underlying paradigms. The Center for Economic Growth wants to hear your opinion as to which 2 or 3 of these recommendations should we actively pursue. If the paradigms were different, would your advice to the CEG change? Might the recommendations themselves change? Are the paradigms we have today OK? Are the ones we just suggested any better? Are there others? What data and research do we need in order to decide? We have purposely not developed details for our proposed new paradigms because we wanted to hear from you which way you think we should be headed. One thing we do know for sure is that to meet Senator Harkin’s challenge and to significantly improve the economic prosperity for people with disabilities, something bold and different is needed.

The Center for Economic Growth looks forward to your input both today and in the months ahead.

Bryon MacDonald, World Institute on Disability, Employment and Disability Benefits Initiative, and David Stapleton, Mathematica Director, Center for Studying Disability Policy, addressed key findings resulting from the previous summits in 2010 and 2011 and provided a statistical analysis of disability benefits.

David Stapleton noted the federal fiscal reforms that are inevitably going to come are also inevitably going to affect programs for people with disabilities. Mathematica’s research recently found 12% of federal outlay in 2008 went for the support of working age people with disabilities.

In 2010 the number of people receiving SSDI benefits was 2.2 billion higher than it would have been had the rates of participation been the same as they were back in 1980.

The Social Security trust fund is exhausted in 2016.

This situation calls for short term relief so that benefits continue while working toward better policy in the long term.

The summit in April was focused on early intervention for workers that experience disability onset and how to keep them in the labor force rather than joining the SSDI rolls. That's the easiest problem to fix.

Bryon MacDonald said this has been one of the more fast paced years in public policy. It seems changes are coming from left and right. The convening we did in April with Mathmatica asked one core question: How could we sit down together and figure out plans, constructs, actionable steps that would reduce application to the SSDI program?

We want employers to support employees that leave work due to accident, illness, surgery, potential work disability, through a new work policy that expands and promotes wellness, health and productivity, policy and practice in a context of workplace flexibility programs for all employees.

A new policy needs to build on what the employers who are doing the right thing are doing.

We want the Office of Management and Budget at the White House to take the lead to authorize, plan, fund and test pilot projects in states today that currently have mandated short-term disability insurance programs.

So we have an infrastructure that's already built. California, Hawaii, New Jersey, New York, and Rhode Island are the states that have short-term insurance programs. We want to use those infrastructures that are already up and running and build pilot projects in those short-term disability insurance infrastructures that test a variety of early intervention design elements that over a short-term could show, or be proven to show, the job retention practices that are going on now spread to more employers in that test pilot states would, in fact, reduce provisions from public benefits because people were staying in the employment arena.

There was demonstration from the Ticket Act, a demonstration to maintain independence and employment that track what this proposal is all about. And there are lots of different findings in various groups that early intervention services that retain employment, save everybody money and keep talent at the workplace.

The major recommendation was for those who had to separate from the workplace and had to go through the process of applying for disability benefits, SSI or SSDI. What we are proposing first and foremost to Congress is that a hearing by appropriate jurisdiction to increase and expand features that could be included in the current Social Security work inventive proposal, known as WISK, be held.

The main policy piece to that pilot project is that once someone is on disability public benefits, work would never trigger a loss of eligibility for the program. You might lose your cash benefit, but you keep your Medicare, and you keep your job, and you would have access to health coverage and employment. But the employment as it's currently today would jeopardize your access to the disability benefit program.

And we feel that the work simplification proposal is a train that's moving, it's already out of the station. Congress should hear more on it with multiple committees to see if we can bring SSI and SSDI, as an example, along with other reforms.

The SSI savers act has been reintroduced. HR 2103 which offers liberalization of the asset rules in the SSI program and substantial changes in asset development for folks who are on the SSI program and is a piece of the future that should be looked at, that is immediate and could be acted on to improve asset building capacities for people with disabilities.

In terms of people who are already on benefits, or who have shown to either State Medicaid or Social Security that they have a significant impairment and have presented evidence that it keeps them from working for 12 months or longer, they have access to Medicaid buy-ins which allow people to keep their earnings and access Medicaid at the State level in about 37 states—each state having different rules, requirements, etc.

The recommendation is for an examination of what a national Medicaid Program would look like that provided the features and asset building and employment outcomes that would improve current Medicaid rules if you are not working, as CMS is attempting to address.

Neil Jacobson commented that one thing that could be done is to use government benefits to pay people to go to work--instead of paying people not to work, pay them to work.

Discussants Comments:
Judy Heumann added that it's really something similar to what has existed for disabled veterans for many decades. It is, because they get a benefit based on disability, based on level of personal assistance needs, housing needs, etc. There is no incentive for those individuals to go to work. They don't lose their health care. They don't lose anything.

Some of you know me. Some of you don't. My name is Ilene Zeitzer, I am an American now living in Brazil, but I worked for almost 30 years for Social Security and had the pleasure of working for Susan Daniels, the Ticket to Work Adviser, before moving to Brazil 5 years ago.

I run my own consulting business and mainly I work in other countries, but it has given me an opportunity, working in more than 50 countries, to see what works and what doesn't. What Judy is talking about is actually the method that's used in the United Kingdom and has been for some time.

You are assessed on a medical or functional model to see if you meet the criteria to be considered a person with a disability. So it's the same kind of method that we would use in the US. But that doesn't end it. It begins it.

If you don't want to work and you meet the criteria, you receive a disability benefit, but if you want to work, then they try to figure out how to help you work. You still get the benefit, but they use the tax system to pay you the benefit through your employer so you are actually getting a supplement to your income based on your disability needs. The transportation, the personal assistance, whatever it is, it's an acknowledgment there is a cost, usually, to having a disability.

So you earn the same income as anybody else. The employer gets whatever help he needs to make your worksite accessible, any adaptations. The employer pays this extra cost to you in your salary. Then he claims it back in his taxes against the government.

And I always wondered why we don't do that because, really, we give so many other things through our tax system. You can take the cost of your housing, mortgage; I mean there are all kinds of things. We use the tax system to promote home ownership. Why don't we use it to promote people with disabilities to work?

And the aspect of it is because the person is getting this through his employer, he doesn't think of it as a disability benefit, he thinks of it as a subsidy for working. So I am just putting that on the table as a possible model that we might try to emulate.

Could I ask how is that working?

It's working very well. They have a good take up. Part of the problem is the government isn't fast enough to deliver all of the extra cost of access to work, it's called. There is a lag between the request that they get from people with disabilities and their ability to deliver. It overwhelmed them, I think, when they started, how many people were willing to work if they had the cost of their additional costs covered. So there is a lag. It's not perfect. You know, it's government, so it's not perfect, but it is working quite well, and many people with disabilities do work in the U.K. The biggest problem is education and skill levels, that kind of thing, which we all know about, but the aspect of dealing with the extra cost of having a disability is being addressed in policy through separating qualifying for benefits vs. how do we keep you in work anyway.

KEN: Byron, I know this is something that everyone at the table knows. Nonetheless, it is still astounding to me 4 decades after the passage of 504 and a multitude of state and federal disability civil rights laws, and it totally shifted the definition of disability. It totally changed the paradigm that we are still saying "Oh, we can't shift the paradigm yet." The paradigm shifted, and just as health care, our vision of health care has shifted, and seeing it through the eyes of independent living and disability rights is reflected in the beautiful NCD reports on psychiatric disability and health care. It's just astounding to me that today we are still talking about, "Oh, we can't talk about shifting the paradigm." Hello, it shifted.

BRYON: I have to add to that because I agree. The reason we have buy in, something central to the discussion, is not because it's buried at the welfare office at the county level, and you never heard of it. The Medicaid buy-in is only a comparable benefit allowed to you if you have a job. You can't get a Medicaid buy-in. You can't get Medicaid with a very affordable premium until you show the state welfare office you have earned income. That is the biggest policy shift. That is a paradigm shift, and its already happened. We are in that paradigm shift mode.

Thomas Panek here. I want to comment on a couple of things and ask for instruction on a particular topic. We know that individuals who have to declare they can't work to be eligible for benefits sometimes can't find work and that's the reason they are declaring that. Why can't you find work? We see in the veterans’ examples, recent examples where the Obama Administration incentivized employers with benefits for the employers. I like the concept of that model. When you speak to employers and ask them, what they say is we are not hiring because there is a difference in the structural skill set of what they are looking for and what that particular veteran is bringing to the table.

I propose there is a structural gap that's even wider of individuals that bring skill sets to the table and what they need to be trained for to take on those jobs. And it is that gap we need to work on to change that number. Many people before me have come up with excellent policy recommendations, so how do you get at narrowing that structural gap of skill sets is what I would like to hear a little more about.

Lynnae Rutlege noted this is a point where we can get ahead of the curve. There is a disconnect, in general, in our economy, including the jobs available and the skills people have which is why even with the high unemployment rate, employers are looking to bring people in on H1B visas, and a lot of that is not having people qualified in disciplines and other areas. We need to find ways to get ahead of that curve.

From an employer perspective on the skill sets, to this person's point by the way, this is work that has to be done. In this economy, the 21st century global economy, what are the skill sets needed today?

I don't believe that, I don't know if there are studies that show that. I don't believe that anybody without a disability is necessarily more equipped to do the work in the demands of the 21st century business environment, the global environment, any more than somebody with disability. I think we have to look at that as well. It seems to me that since this is designed to sort of have this discussion, make recommendations, and then decide where we go, this needs to be part of the discussion.

I would like to interject a thought. My name is Fernanda Costello, and I do emulate a lot of my peers who are seeking employment or a place in the workforce. What we seem to forget and employers forget and even the person who’s applying for the job is before we got injured we had experience. We had built in skills. Somehow, when I go for any kind of interview, that is not played into consideration because it's been 15 years, and anything that they say about my resume, you don't want to talk about past ten years ago.

But by golly in the 15 works of time, there are many of those who have put in volunteer work. That's skill building. That is experience. Just adapting to day to day living is experience in itself. We can bring that into the workforce.

I am aghast that we have opportunities for students, if they want to choose an internship, they can. But how many of us or employers are opening up the window with that same kind of dialogue? Yes, you were experienced before; let's bring your skills up to speed. You can still relate to people. You can learn there are all these technology devices that have come to play in the last 15 years to make it easy to access and interchange with information. Distance is no longer covered; it's not frustrating; it is enlightening in at the same time, because employers, really, need to address the fact of what can we do together? Not so much how can you fill in the description. Even a normal person cannot fill in the descriptions as far as a job description is concerned.

I have logged in this year, alone, over 1,000 hours of volunteer work. But is somebody willing to employ me? I have to look at two things. Do I want to be an employee? Or do I want to be a contractor? Being a contractor is being a lot more attractive to me because I gain experience off everything on my work related experiences.

Being an employee, I cannot. So that prevents me to bring my income development on a forward direction. So if I become a contractor, myself, I can still use my volunteer hours to defray some of that work related experiences. I can defray everything that is needed for me to get to work, with assistance or no assistance, with a accommodations or no accommodations. And really I do believe with employers today, especially in the Bay Area, that they are willing to negotiate that with you because the skill sets are here. We are not given the opportunity to work alongside one another. There was a time when I interviewed, and they didn't know what to do with me, whether I am going to be in the backroom or be the poster child receptionist up front. These stories are right, because I thought I would be the only one. The more I talk to my peers it's the same story.

So addressing the paradigm, move, yes, we are there. We are shifting constantly. But what I would like to engage with employers and potential employment seekers is let's negotiate it rather than stick so much on structure of the policy because you don't know what I can bring in.

Susan Daniel: I have been on the WID board about 15 years. For about 20 years I was the head of HR and second head of HR at a very large Silicon Valley company. But I know a lot about hiring, and I had a lot of experience with that.

My view is that employers today look at people with disabilities as a functional cost centers and not productivity enders. It is an inaccurate view. So I guess to me, one of the things I heard today, and I think might be important to again engage employers in this whole concept of either tax credits or other way to incentivize employers. Once employers have people with disabilities on their workforce they realize that there is a thought pattern they had that is inaccurate and wrong, and it has been in place for a long time and very hard to change. I guess I have been consulting for the last ten years. I've worked with large and small employers and it is very, very, hard to change that thought process.

I think with the business community or employers in general, the reason it's hard to change is because they think it's hard. So they are thinking they are putting obstacles that are not necessarily there, and then it comes to performance you find out that really people perform better or worse, and it doesn't matter whether or not they are disabled. I think this issue, impart the opportunity, because Neil's approach is taking us to this next frontier. Maybe it's to get corporate America around the table again and to have this kind of forum with them and to engage them to think about ways in which we are not just talking about the physical accessibility of a building; we are talking about policies that really help your bottom line, help you to be successful and that help you to draw the best and most talented employees regardless of where they come from. And that they are willing to get engaged. If you have a solution, if the public sector can also come to the table and be similarly engaged, my sense is that if you, in a sense, lead by showing them the way and it might be more enabling that way. So somebody else has a comment.

I am Robin Nagel. First of all I am really thrilled to have been invited to join you this afternoon. I do represent a project at Kaiser Permanente. It's a project that is from Hawaii to the East Coast for the entire workforce. I will speak to that, some of these points that you raised in just a moment, but forgive me I have to share this with you.

I have a special greeting to everyone in the room from the Advisory Committee to the International Forum of Disability Management. They met at the Royal Society of Medicine this morning, our time from 1:00 am; I excused myself at 3:00 am. In particular, a special greeting to Kathy Martinez, who I think has been asked to participate in that.

A lot of discussion around 2:00 am was around bringing representatives of nations together to talk about the multiplicity of approaches to this very dilemma that you are focused on today from different national and societal frameworks, and it boiled down to this: How much government direction is desirable? How much partnership engagement, social partners? The best I could make out from the British perspective, maybe you can help me with this too, is really labor and not for profit organizations. WID would be considered one of those social partners. Then from the private sector, which I sort of represent, the private and not for profit, because Kaiser is a not for profit organization, it is important that you are all having this discussion now. And it is going to be important at the global meeting as well. That meeting is taking place in London, September of next year, and it's no small thing that it's hosted by the Royal Society of Medicine. So that's the other thing that I want to reference with respect to my experience at Kaiser.

I led the disability management project for the workforce. I have been there five and a half years. And as Neil and I used to gnash our teeth in Oakland a few years before that, it is the physicians, significantly, who define who we are and what we are and what we can do and what we want do. Or they don't define it at all because it is too much trouble, and they force us all to a default mode in which we are presumed disabled.

I know what even the language of the ADA has to say about that, but I would suggest, and this is the approach that I am working on with my physician partners at Kaiser Permanente, that we let go or have a time out for the use of the term, "disabled." Use it as a legal term with benefit association, and leave it to functional impairment vis-a-vis whatever activity is undertaken.

We are trying to align our thinking with some of the best language that's recently come out of the World Health Organization on this topic, the paper that was published in June of this year, and particularly on the employment of persons with disabilities, really looks from a clinical standpoint at a simple concept which is: Do you have a functional ability to do whatever it is that you are trying to undertake? If not, how can we help you? If so, then that's the end of the discussion with regard to workplace definitions.

I don't mean to speak in any way to the benefit side of this, which you all are the experts in, and I am not at all. That has its own integrity. So I think that my own experience addresses all these issues, kind of personally as well as professionally.

From a professional standpoint, it is very clear to me we could move to integrative management for the workforce of 187 employees. 98,000 are represented by 30 plus bargaining units, unless we did it in prison. Unless management and labor got together on it, by the time I got there, and asked the embarrassing questions of, where are the doctors? And I got a lot of looks and response and said, "This is a lovely idea, but you are a health care organization; let's get the doctors to the table." So that's what we are in the midst of now, and we have a model that is physician engagement for the clinical orientation of activity as a part of life which translates to work placements. For others it means schools. It means community service. It means a lot of things depending who you are and what your life consists of. And we have our labor management agreements in our national agreement. It is all written out there that we remove barriers from keeping people working safely and productively that require functional impairments along the way.

My career began after I finished grad school in 1980. I was completely unfettered. I had no idea in 20 years later I would be diagnosed as somebody that has physical impairment; if I didn't stay on the up side of the curve, I really get it in a way I possibly couldn't have understood it 25 years ago.

It's that need, human need, and this is again partly what I have learned from our international partners: it’s human need to be actively engaged in life. That's the paradigm that I am concerned with and that our contributions should be understood in that light. Economically, we can't afford anything but that. We need all hands on deck and all people that can contribute productive work to do so. And we can't pay people to get worse or disengage in productive work.

Excuse me for just blurting all this out, but the International Forum on Disability Management is a powerful tool for heightening our recognition of the global needs that we are speaking of. And I just want to say that they would all be very pleased, and they actually do know I was joining you today.

Good.

VIDEOCALL: Is there any data that has been gathered on the Kaiser model and other models that demonstrates the interventions that you are using are offering payments of benefits and the value of being able to extend this both to large employers and middle level employers and smaller employers? Is there any research done on this?

Thanks so much for asking that question. We are pushing our own envelope in that regard. It's not a very complicated set of data if you boil it down to days away from work for personal illness and days recovered through, what in the U.K. is called, "graduated return to work." At Kaiser Permanente we call it "transitional return to work." Whatever that functional impairment consists of and for whatever reason, whether it's work related or not, when it reaches the threshold that we consider the reasonable end of transitional, temporary work, if the condition has not fully resolved and it is not expected to fully resolve in the immediate foreseeable future, then we have a mechanism in the interactive process for reasonable accommodation under the ADA. That is beefed-up across the country thanks to the amendment acts. California is used to undertaking that process a bit longer that you say because of state law.

The data is, the matrix is lost time vs. the recovery time, so we try to express this in our own internal metric as percentage of lost time that is recovered and returned to the organization. Just a figure off the top of my head. This is not published because it is really internal, and I don't know if they care for me telling you these details, but never mind.

In the year 2010, by our very minimal proficiency, we are able to calculate we recovered 400 FTE, 400 equivalent temporary employment. So I know we can do better, Ken. Kaiser Permanente is contributing valid data. We have lots of work to do on the on the ground. We are not there yet but just introducing the tool.

VIDEOCALL: As I understand, one of the things that is supposed to come out of this meeting is an agenda for future activities to achieve the objective that you originally laid out; is that right?

Yes.

VIDEOCALL: So then one of the issues that's being discussed, Patrick, I think you raised the issue of working with employers. There are many different employer models that exist in the US, like the US Leadership Network and others like Kaiser Permanente that need a hand in the kind of research, potentially the research that needs to be done to legitimize and elevate work that Kaiser is doing. So in the next little bit of time, are we going to be laying out what we see as the next steps that you want to be engaged in?

Yes.

VIDEOCALL: Okay.

ANITA: What we hope is we will plow from out of these meetings the action items, the minutes, if you will. And then ask for people to keep that dialogue going.

VIDEOCALL: Thank you.

I would like to get back to this idea of early intervention and what's been done on that. I can't remember the exact year; I want to say about 2002, but I could be wrong. It could be 2003. There was an international study on people who left work specifically because of back problems, very specific definition of what those back problems were. It could not have been from a disease or an injury, just non-specified back pain. Why back pain? Because other than mental illness, back pain is the second leading cause of people going out on disability. Mental illness is the first. And the highest reason for physical disability claims is back pain.

So there was a 6 country international study where it's actually, I think, the only study that had actual cohorts. Each of the countries, Sweden, United States, Israel, Germany, and Denmark, I think, did I mention 6?

5.

Who did I forget?

Netherlands.

Netherlands, thanks you Kathy. The result was a book, "Who Returns to Work and Why." It was a study where each of the cohorts was 400 to 500 people who had left work because of back pain of a non specific nature, and people they recruited for these cohorts to measure them at three points along the two year spectrum, was 3 months. 3 months out of work because of this back pain.

Now, why am I going with this? Well, Byron mentioned the 5 states that have short-term disability. And that's where the US Social Security Administration had to draw the cohorts because normally people don't even get to file for disability benefits under Social Security until they have been out of work for at least 6 months.

That broke; if you waited 6 months, it wasn't early intervention any more. So they had to use cohorts from the states that actually had short-term disability. So we wound up using New Jersey and California. And the interesting thing was that in those states with early intervention, we all thought the US is going to come out at the bottom of this, of this who goes back to work study. We were all very worried at Social Security. It turned out the US because we bridged it, in a sense, we used just two states where there were short-term disability the US came out in the middle. And oddly enough, the country that did the best, 72% at the one year measuring point, and 70% after two years, was the Netherlands.

And Germans did the worst because only their blue collar funds participated. It turned out through an audit; the tests had the least education and most arduous work and were ten years older than typical cohorts that they studied. So that probably had an adverse effect and that's why Germany, who everybody thought would do the best, did the worse.

The point in bringing all this up was to say that the possibility for early intervention made a huge difference. Social Security has never been able to, no matter what they talk about, do early intervention because it's too late by the time they get in. And they already determined the person is disabled. Then you are trying to convince them they should go to rehab.

We need to think about doing some studies, and maybe the way to do it is through the states that have these early or disability programs to see what could happen if we get in early to deal with people who would probably be determined to be disabled. I mean, at the end of the line if you do nothing, they are probably going to meet the definition of disability.

What happens if we get in there early and try to work with the employer, to get an accommodation, to see what the person needs at home? Had transportation been an issue? What happened if we work with at least people, identify the people and get in early to change outcomes? That's what Social Security has never been able to do except in this back study.

I would like to chime in about the ability DC comment….

VIDEOCALL: One of the things we talked about a lot in April is that we have some of the data already. We know the companies, both employers and insurance companies have done a lot of work in improving return to work for people with worker's comp, from injury and for people on company paid long and short-term disability programs, because there is an economic incentive to do so.

The question is when we have injuries where the employer doesn't have such a direct economic incentive to get the person back to work, how do we set up a system where we use those practices as well?

One thing we talked about earlier is we know the universal availability; the Workforce Flexibility Act revised some of that support. The employer has a policy to allow people to come back on a part time basis. That we know. I propose we talk about in April, how we expand those best practices. It is hard because sometimes employers don't even know what's going on or that there is an injury or illness. But that's my question for the group.

Excuse me I wanted to add… When we speak of "we," the royal we, needs to intervene early in the workforce operations, I couldn't agree more with this very important factor, and that is without clinical opinion, in support of clear activity guidance for those effected individuals. You could have the most beautiful return to work, early intervention program in the world, and it won't happen unless you have actionable information that is timely and that reflects what the individual can safely do and must refrain from doing during the next interval of healing. That is our big struggle right now at Kaiser Permanente because we recognize it. But bringing about that kind of change is another big paradigm shift in medicine. I think, again, I mentioned the fact that the international forum is hosted by the Royal Society of Medicine, they seem to be getting a grip on it over there. They've a top down government mandate to refrain from writing people off work through the national health system. Karen O’Block, the person who is executing the strategy, pulled the plug on the sick note. In this country sick notes are written unabated. People are written off work for months at a time without any particular intervention.

My point is we need to knit those components together, whether on a policy level, I have no idea. This is my day job, knitting these two components together so we have actionable information with the catchers mitt of the workplace operations ready to receive that person with some functional impairment.

KEN: I think that could be a real dangerous sword to rely on, clinical guidance. We know the clinical profession, as a whole, has a huge, astounding misunderstanding. They don't understand; people who have the disability, themselves, know best. So I worry when I hear, "we have to rely on the doctor," because we get in a huge amount of trouble.

There is a medical role in the middle of this from structure, today.

I want to share one resource for the record, you maybe remember. It is a compendium of scientific evidence which possess the point of the study you were referring to and it is probably referenced. It is called "Is work good for our health and well being?" And it was compiled by two physician professors of renown in medicine from the U.K., Gordon Waddell and Anthony Kim Burton from the University of Cardiff in Wales. They reviewed all the scientific evidence on this topic internationally, many, many, many, studies, good clinical studies, and they organized it in this compendium commissioned by the government of the U.K. in 2006 to vet all these studies and rank them according to scientific strength, and it is organized topically by types of conditions: mental health and various kinds of physical conditions, back pain being a prominent one and other conditions being acknowledged. It's a very useful tool, and this is what we are trying to use as the foundation of our influence on the 14,600 physicians of Kaiser Permanente. It's a job.

VIDEOCALL: I just want to go back to Robin's comment, and I agree wholeheartedly. I think we actually know a lot in the private sector and work, worker's comp and about ways to help people get back to work. And I think that the problem we face, I mean we could always do better and hear more about that, I don't think that's the big problem right now. I think the problem is we don't have a policy that encourages employers to do that. The big question in my mind is how do we move from our current policy to one where those types of services are available? They are available on a timely manner, the employers have incentive to retain the person as opposed to let them go.

Neil. I worked for a big corporation my whole career. What I love is if you do a good job, they could care less what you look like or sound like. All they care about is money. Money, I like that. I like that. I believe that we live for betterment. The real problem, I believe, until we have a basic paradigm.

So the basic problem. He was an executive at Wells Fargo for most of his career, and what he notices is that the problem is not necessarily the corporation and their not wanting to hire people with disabilities. That the problem, and in fact, in a financial sector, I would probably submit any sector, the issue is the bottom line. The idea is how do we change the paradigm for people with disabilities in that community to be able to believe that we have to work. It's not that we can't work. It is that we have to work.

I am on the board, and I can argue with him. I also agree that part of that is true. I also think that institutional discrimination is still acceptable. How many companies today look at, from end to end, hiring to retaining workforce, make sure the web sites are accessible so people will apply and use the resources; how many of them make sure they do outreach? How many make sure they are aware that there are interpreter and other services around? I think there is a huge attitude, and it is in the government and in the private sector. There are companies like Kaiser, Verizon and AT&T and Wells that have done a good job of having people who are employed and that track and expand upon it.

I think today, there is still the idea that we think we just need to tell them that people with disabilities can work and that's okay. That's not enough. We need to enforce, when they have laws on the books, saying, you have to hire; if you are a contractor, you have to hire people with disabilities. That we are enforcing them. We need to make sure that 508, which says our web sites and public accommodations and what we purchase has to be accessible, is enforced.

There is a huge part of that as well. As well as the matching of skill sets. There are a lot of things going on, and it goes to the complexity. I get tired of people saying, it is because we can't. I think people learn to become helpless and that discrimination is so great they give up. And it goes on in our society as well. There needs to be some of this placed on the employer as well. Part is for the data, which works for the bottom line which is critical. There has to be enforcement where we say discrimination is wrong. I bet if you go to many companies today, and they say we didn't hire this person because they were deaf, and we were concerned about communication. You have a significant number of people saying, that's a concern rather than that's discrimination.

If I could make a comment. Susan Daniel said half an hour ago that the perception is you cost me money. Not you make money for me. I don't think that's gone away. I don't think it may have gone away at Wells Fargo.
As someone who has done a lot of hiring… I think a couple of questions out here that are coalescing and converging. First of all, it is very easy to get to point by asking the questions.

If we enforce disability laws the same way we enforced Title 7 which goes back to racial and ethnic discrimination, do they think it would not be the case that more people with disabilities could have jobs today? Of course, employers in fairness, to Neil's point, I suppose, do say we are not discriminating; it is pressure of the bottom line, but enforcement of the law would go to that glib.

Does it really cost more on the bottom line or not? If it does, then you have to vet that complication. And the number of proposals suggested here, and there are others that are suggested as well, there are ways to involve federal funding that would involve… (not audible).

Skills are another impression. One way to look at it is we started out talking here this morning or a few hours ago, but really only a few minutes, we started talking about the question of how to use the benefit system to bring about employment and facilitate employment. How we can make it a source of empowering employment? Now we are talking about employer attitude.

The further question is, how do we relate those two discussions in a coherent and comprehensive way that makes sense to the unifying of the policy?

I know we are running out of time. There is past, present and future, and the discussion seems to have gone around that. I am hoping much of our thinking is future oriented. I haven't read, but I was told about an article in The New York Times today; it is a distinction between social justice and civil rights, and civil rights being a bit of an older paradigm. In the context, it speaks to the future. I bring it up because it finds new ways around issues, and the issue around workforce and jobs generally in the world and in our communities are not entirely separate from people with disabilities. And I think it's important to be thinking about, not only the bottom line but, the idea of inclusiveness now that all the retraining issues, all the issues about how do you become a world class workforce to compete with the person in China, whether or not, you include everybody in that retraining. And we make sure that all age groups, and all people in and out of the workforce, isn't as important any more. It is totally new ways of working and totally new skills. Lots of people need to be retrained. I just think the discussion about what people are doing right now, and how they think about it now, I think employers who view any employee as a cost may or in traditional ways may not be competing effectively of trying to find the best use of the job. I am not being specific.

One thing that popped to mind - transportation is an issue. Like you brought up the… we need to think about transportation period and how and where jobs are done. What's good for people with disabilities is good for the workforce in general.

What I am trying to say is, in the context of future jobs, I recommend Tom Friedman's new book.

VIDEOCALL: I want to come back to a point that was raised in DC a few moments ago, briefly.

It has to do with the carrot and the stick. Of course, there needs to be a stick of enforcement, and of course, there needs to be changes to the benefit programs that change the incentive and motivations for individual.

But if we go back to where Andy Imparato was, hiring people with disabilities, people have to do the hiring with the employer. I had a chance to talk to Andy in a small group, and he said over and over again that he would like to see policies that change the business case for employing people with disabilities.

So that speaking to marginal incentives and has to reach the bottom line. It also deals with the perception issues people have been talking about. I know the companies represented in the room in Berkeley; they have a perception that's been changed by actually doing things. A very powerful way to change perception is to try to get people to try things they otherwise wouldn't try and prove it to themselves. The business case is not what they thought it was.

So I just want to not dismiss the notion we need more stick, but we need carrots, they need carrots that appeal to employers.

VIDEOCALL: I think employers were able to demonstrate what they have done to keep people in the workforce is one area that I think is very important, because of the Kaiser data and the data from these other companies is, in fact, showing that they are able to keep valued workers in the workforce, that they don't have to go out and recruit new people and invest in recruitment and retraining. It's the bottom line Neil was discussing earlier. I'd really like to see data on that, that it really is showing its value, and learning more in depth, so there could be more stories out there to the Congress and to others about how being proactive makes a difference.

I agree with that, and I think hopefully this will be the by-product of some of the work we will be doing together.

Let me back up to Sam's point. Neil and I had this conversation before. I said, we are not talking about scrapping the ADA. We are not talking about going backwards. We are talking about going forwards. I think, for example, you mentioned Kaiser, Verizon and AT&T; we didn't get here by ourselves. We got here because there are informed people within the this room to really help us to understand what we were doing well, what the opportunities would be, and, for instance, this notion of universal design. We found out if we actually design our products so that it could satisfy the entire universe as opposed to a specific segment of society, we would be more successful and sell more phones, etc.

We were able to do that, not perfectly, but we were able to get to that place. I think we are a better China and more successful for it. I think what Neil is introducing and we around the table are talking about the new frontier, about economic development, about economic opportunity.

Andy put a metric behind it, about 6,000,000. I think we should, I don't think we should lose sight of that. I think while we are on that path to sort of get to that 6,000,000, there are things that we have to do to change the mindset, to change the paradigm, to be able to educate people within the disability movement, to get the best practices, to get the data points, to get informed about what policy work, best practices incorporate America. My sense is the wonderful opportunity that we have here is that we can sort of continue to hold ourselves and others accountable for where we are and where we need to be, vis a vis some other points that Susan raised. But also the opportunities of where we need to go which looks like the England model of what we need to adopt to have real economic inclusion in a way that addresses what Sam is talking about, which is really this is a completely new world, everybody is talk STEM and technology and IT, what does that mean? How can we be part of that and actually lead that as opposed to hoping that it's addressed for us when it's being implemented elsewhere.

Were we? At neat take.

ANITA: Wouldn't it be nice if I had an answer.

Ilene: I want to put something on the table in terms of policy changes, and put questions on the table why don't we think about this? One of them is several years ago when Social Security became an independent agency, the deal that it made was that the Republicans wanted the earning test to be moved for people who stayed in the workforce until retirement age, between the beginning of retirement age and when full Social Security kicked in, and it was removed.

So now, if you stay in the workforce it used to be you lost, if you continued to work, you lost a certain percentage, 1 dollar for every $3, and Byron correct me if I am wrong, until age 70 until the only earning test disappeared. If you continued to work past 70 you could keep your Social Security and anything you earned.

In that period in between, you were penalized if you worked. As part of the deal with Congress to make Social Security an independent agency, that earning test was removed, and now retirement age is 66; it was 65. If you work between 65 and 70, now 66 and 70, you can keep however much you earn, and you can get Social Security. So my policy question is, why can't we do that for people with disabilities? Why did the earning test removal only apply to elder workers, when if you could qualify for disability, but you continue to work anyway, but you would meet the definition, why is it that you are penalized if you work? Why are you penalized financially? You can't earn too much or you lose your benefit. Why can't we treat people with disabilities who had qualified but could continue to work, why can't we treat them the way we do people who are between 66-70? That's policy question number one.

Policy question number 2 is the worker's comp program is experience rated. If you are an employer and you have you send a lot of people to worker's comp, you pay a higher rate the next year. Your payments go up. Why can't we do that to employers who send too many people on to disability?

That would be really nice.

I am serious. You are talking about incentives. Carrots and sticks. So, the carrot is you do a good job of reintegrating people who otherwise go to disability, you get some carrot as an employer. I am saying, why can't we take some of the policy we use in one system and try to apply to it employers and to incentivize people in Social Security?

I have to add this comment if I could. In all my days I never thought I would see Ilene represent something that Rich Burkhauser put on the table.

I didn't know Rich does that.

I want to say that the State of Oregon, Department of Labor and Industries, which governs the workers compensation for the state of Oregon, has extremely good policy in this area. Everybody wins. It even pays into a fund that provides accommodation equipment or material for anyone who needs it. If it is personal accommodation equipment or material, the employee keeps it. If it is institutional, the employer keeps it. It's a payroll contribution. Pennys on the paycheck. And they call it the "Penny's Program," but I want to emphasize, in concert with this good policy governing workplace preferences or behaviors, there is policy that coaches the physicians who treat work related injuries in the State of Oregon with an activity prescription, with a model that teaches the prevention of medically unnecessary work disability and requires they undergo training in learning the principals of medically unnecessary work disability so they can appropriately provide activity guidance to their patients.

So that's an example of the dove-tailing of this clinical orientation towards sustaining productive engagement with the institutional orientation towards accepting or keeping employees with functional impairment at work while healing, if the impairments are durable, persistent, what have you, keeping them with accommodation. So it is really a 360 degree orientation, but it is only the occupational program and doesn't include short-term or long-term disability. We are trying to incorporate that model, but it is a huge undertaking, because it is from the bottom up. It is a grassroots effort, and I love what I am hearing about these ideas for policy that would give some direction to the powers that be.

We could take one more comment, maybe two. We have this gentleman here.

Thank you very much. I don't mean to throw cold water on this, but I am going to predict that 5 years from now, unemployment rate for people with disabilities is going to be worse than it is now, and the reason I fear that that will be the case is because the biggest thing that makes people with disabilities competitive in the job market is education. If they have the better credentials, they have the better shot of getting a job. While the United States spends a lot of money or employment for people with disabilities, it spends very little money on people with disabilities at the post secondary level.

That responsibility has been left largely to the states. Well, the states are broke. For example, the California community college system which went through a terrible cut in money, and that is where most people with disabilities get their education, cut the money it spent on an individual with disabilities 5, 6, 7, ten times as much as it cut the rest of its budget.

So it's not like everybody is going to feel some pain. There are some communities that are going to feel a lot more pain than the rest of us. And this is the pipeline, guys. And let's look, for example, at the wounded warriors who is going to increase the numbers of people with disabilities significantly.

The United States has come up with the most generous post secondary benefits since worker's comp. Good news, and most of them are individuals with disability. Good news - more money for them to go to school. If you are an individual with a disability, that money is not going to get to you the goal line. It will get to you into school but wouldn't get to you the goal line.

What is the United States doing to fund the cost for people with disability, you know, interpreters, alternate media, the special dorms. State of California stopped giving people money for personal assistance which many individuals need to go to school. They are not there. They don't exist anymore. The pipeline is shutting down. If you all as employers don't also keep your eye on the pipeline you are missing a big source of the problem in the future.

I think you are on to something. We haven't addressed, and by the way, the pipeline issues are across the board with people higher education and skill attainment. This is something that the Center has to take into account, how we attack that.

The metric they look to improve, they track Hispanics and African Americans and their performances on the SAT and PSAT and the AP courses, but there is no obvious metric for people with disabilities. I think we know where to go to get some of that addressed. And I think we need to as part of this effort.

This issue, it is a drop in the bucket. My experience teaching at Cal, some of the federal grant programs that are designed to assist students from underrepresented groups to go to graduate school, whether it's in the STEM fields or in other fields, the national programs I am talking about have incredibly uneven inclusion of disabled students as a category. I am not talking about disabled students who are called underrepresented in some other underrepresented?

It is not clear those students qualify for these programs. And there is individual fussing and fighting that goes on. But that's a tiny pipeline issue that needs to be addressed. There should be some national policy about what under representation means for any program that is attempting to get students through college, then through advanced degrees. And there is so little support in general because of budget cuts, but already because of attitude. For students in graduate programs, there is so little understanding of what it means to accommodate adequately a grad student. It is completely undergraduate centered at its very best.

I am John Greener. And I have been public school teacher, administrator for 30 years. And I am thinking along the same line as Susan and I didn't get your name.

I am concerned about the kids who are in public schools, graduating from high school, what does the data show today as far as them going out into the workforce and getting into the universities in the first place?
Are they prepared?

I think the answer to that is, if you look, I don't have all the statistics, but the numbers are not good. The graduation rates out of public school systems are not what they need to be. The emphasis on the STEM disciplines, let me not use the acronym, math, science, engineering and technology, the emphasis are on these are not there. We find the metrics are strong and we are not competing well with kids that are coming out of European schools or Japanese or Singapore. My kid is seven years old and he is learning Singapore math. Arnie Duncan, the Secretary of Education is trying to do race to the top. And try to get innovation in the schools and address the disparities between African American kids and Hispanic kids who are dropping out twice as fast out of school as the rest of the population. So it's clear that it is going to have also a disproportionate impact on people with disabilities.

So the idea is, how do we reform the system? I am not sure this is our job to do. But certainly I think we need to, as you pointed out, we need to understand what the metric show, what the data shows as it relates to people with disabilities, what's going on that we could benefit from. So I think we need to do a little bit. I heard somebody mention earlier we need to do research in that area and be able to respond based on what we know. I am sorry I didn't have any specific numbers.

Could we hear from Linay?

VIDEOCALL: I am concerned we are getting up to 6:00 o'clock. But I think there is research out there, there is data out there about the outcomes for students with disabilities as they leave secondary education. I think that data is there. We have data in the public vocational rehabilitation system about the outcomes, which are dismal, outcomes for people with disabilities who have completed academic programs and still can't get jobs. I go back to the comment that was made about the mismatch of the skill sets that people currently have is what employers are looking at. I think we have been across the map for the last 3 hours of so many places we need to impact policy as well as corporate practice.

I am at the point where do we go from here? How do we take advantage of what we know? How do we leverage the research capacities that are out there to give us more data to make the more compelling arguments? How do we do that in a way that is really going to have an impact.

ANITA: In terms of today, we have 3 sets of goals to keep things moving forward.

The agreement we made with Andy Imparto is that any solutions from today we have, we’ll have someplace to take them for the next level of review in terms of the health community office.

We want to pull apart this discussion and categorize it so we are capturing, in chunks, if you will, the issues that came up and figure out-do we need to keep discussions going here? Do we need to put together a group of people that can push them forward? Does that need to be RSA, you know, where do we need to find a place for them to live that will not let them die away?

I think there are some common themes, that research needs to be there to demonstrate what we need to have happen to make a paradigm shift. So we value hiring with people at disabilities at the bottom line. That has to be gathered. I think there are other issues that were raised that are common things, and maybe it would be helpful to go back and have people work on those directly.

VIDEOCALL: I want to follow-up on the statistics around education that are available. We will get them again on Wednesday when we have the release of the Annual Compendium of Disability Statistics. They are dismal. My understanding is it’s a drop of a third: a third fewer graduate and a third fewer go on to college. A third fewer of that go to college and then a third drop.

We heard a specific policy proposal, programs around the science, engineering, math, programs. The standard is you have to be a underrepresented group to qualify, that that people with disability could be included every time. So Andy's proposal is important. And one more point on the education: people talked about the college board and what it may say… we want to keep in mind what their practices continue to be around theirs and other testing agency around accommodating students with disability at that critical point because that creates another point where students are disadvantaged.