The National Multiple Sclerosis Society supports HB 1640, to increase the affordability of Medigap plans for Virginians under 65 eligible for Medicare due to disability, including Virginians with multiple sclerosis (MS). MS is an unpredictable disease of the central nervous system, impacting an estimated 1 million Americans. Currently, there is no cure, though significant progress is being made to achieve Society’s vision of a world free of MS. Symptoms vary from person to person and may include disabling fatigue, mobility challenges, cognitive changes, and vision issues. Early diagnosis and treatment are critical to minimize disability. Most people are diagnosed with MS between the ages of 20 and 50, in their prime working years. Some people with MS may become eligible for Medicare initially due to disability rather than age, and many may seek supplemental Medigap insurance in order to afford out of pocket costs. While the Society was proud to support SB 250 in the 2020 legislative session to expand Medigap policies to Virginians under 65, for people with high-cost chronic conditions like MS, many of these plans can be prohibitively costly. For people on a fixed income, including those who rely on Social Security Disability Insurance or Supplemental Security Income, it can be difficult or even impossible to afford health care cost-sharing, because their income has to stretch to cover other living expenses. Access to a Medigap plan with an affordable premium could ease some of the burden of cost-sharing for this population. For these reasons, the Society urges a favorable report of HB 1640, which would prohibit insurers from charging individuals who become eligible for Medicare by reason of disability and who are under 65 premium rates for any Medicare supplemental policy that exceeds the premium rates charged to those 65 or older. Thank you for your consideration. If you have questions regarding the Society’s position, please contact Shannon Wood, Director of Advocacy and Policy at shannon.wood@nmss.org.

Dear Chair Webert and Members of the Subcommittee: On behalf of the thousands of people we serve in Virginia, including the 20,942 Virginians currently living with kidney failure, I respectfully request your support for House Bill 1640, which would allow End Stage Renal Disease (ESRD) patients under 65 who are enrolled in Medicare to be eligible to purchase Medigap plans. This bill will provide a one-time, 6-month guarantee issue open enrollment period for eligible Virginians who are already enrolled in Medicare Part B and provide premium protections that ensure plans are affordable for those who need coverage. The American Kidney Fund (AKF), based in Rockville, Maryland is the nation’s leading nonprofit organization working on behalf of the 37 million Americans living with kidney disease, and the millions more at risk, with an unmatched scope of programs that support people wherever they are in their fight against kidney disease, from prevention through transplant. With programs that address early detection, disease management, financial assistance, clinical research, innovation and advocacy, no kidney organization impacts more lives than AKF. As you may already know, most people with end-stage renal disease (ESRD) become eligible for Medicare, and most of them choose to enroll in the program as their primary health insurance coverage. However, for many of these patients, private supplemental Medigap insurance is needed to afford their cost-deductibles and co-pays, since Medicare covers only 80 percent of the costs of medical care with no cap on out-of-pocket (OOP) expenses. ESRD patients have complex health care needs and face high out-of-pocket costs: OOP costs for ESRD patients on Medicare can be as high as $18,000/year. Unfortunately, not all Medicare beneficiaries have access to supplemental coverage because in 20 states, including Virginia, insurers are not required to offer Medigap to ESRD patients under the age of 65. Nearly 50 percent of dialysis patients in Virginia are under 65.[1] Further, without a Medicare Supplement plan many patients are ineligible for a transplant because they are considered “under-insured.” Since a kidney transplant is the best treatment for those with ESRD, it is not an understatement to say that this legislation could be a lifesaver. A transplant also could lead a patient to return to a normal life, gaining back all the hours previously spent in dialysis, allowing them to return to work and private insurance plans. We are grateful to policymakers in the Commonwealth of Virginia for previously implementing policies to ensure that other disability communities under 65 have access to Medigap plans. HB 1640 will ensure that this vulnerable population of around 3400 ESRD patients are eligible to purchase plans and not practically denied coverage by providing the premium protection that will make plans affordable. Presently, premiums for Medigap plans issued to qualified under 65 subscribers can cost up to 300% more than premiums paid by those age 65. This legislation will not only save lives, but also will make it easier for patients to cope with the serious financial challenges that come with being diagnosed with ESRD. Thank you for your time and for your consideration of this important legislation. For all these reasons I respectfully ask for your support for HB 1640. Sincerely, Jon Hoffman American Kidney Fund Senior Director, State Policy and Advocacy

Comments Document

Dear Chair Webert and Members of the House Commerce and Energy Subcommittee; On behalf of Virginians living with ALS, we respectfully request your support for House Bill 1640, which requires insurers issuing Medicare supplemental policies, typically known as Medigap, in the state to offer these policies at an affordable rate to all patients who are eligible for Medicare by reason of disability, including patients with amyotrophic lateral sclerosis (ALS) regardless of age. As you may already know, most people with ALS become eligible for Medicare Part A and B regardless of age the month their Social Security disability benefits start. Most patients choose to enroll in Medicare as their primary health insurance coverage. Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. Part B covers outpatient care, durable medical equipment, ambulance services and mental health. However, for many of these patients, private supplemental Medigap insurance is needed to afford their deductibles and co-pays, as Medicare Part B covers 80 percent of medical care with no cap on out-of-pocket (OOP) expenses. Medigap plans may cover some of the costs that fee-for-service Medicare does not cover such as copayments, coinsurance, and deductibles. ALS patients have complex health care needs and face high out-of-pocket costs. The average annual OOP costs for ALS patients on Medicare can be as much as $82,500[1][2]. This can present significant financial difficulties for ALS patients and their families, sometimes leading to heart-wrenching decisions such as whether to seek certain types of care or face bankruptcy. Federal law does not require private insurance companies to sell Medigap plans to people under age 65. Most people who develop ALS are diagnosed between the ages of 40 and 70 with the average age being 55 at the time of diagnosis. The lack of federal protection for Medicare eligible patients under 65 has resulted in an uneven patchwork of state laws on this issue. Under the legislation (SB250) that Virginia enacted in 2020, Medigap insurers in the state have to offer at least one plan on a guaranteed-issue basis to Virginians who become eligible for Medicare prior to the age of 65 due to a disability. However, currently insurers are not required to offer Medigap to ALS patients under the age of 65 at the same rate as those that are 65 and over. People with ALS are paying nearly 250% more for their premiums than those 65 and over.[3] If passed, HB 1640 would fix this. We believe that expanding Medigap coverage to Virginians with ALS under the age of 65 at an affordable price is an important and concrete way elected officials can support those with this life-altering, expensive, and devastating terminal disease. Thank you for your time and for your consideration of this important legislation. For all these reasons we respectfully ask for your support for House Bill 1640. Sincerely, Lindsay Gill Managing Director, Advocacy The ALS Association lindsay.gill@als.org

Please support all persons with disabilities the right to obtain no less than minimum wage for all work performed. Thank you for recognizing the abilities of all Virginia’s workers. Sharon Bunger

First I am very disappointed that virtual comments are closed. In reference to HB1905, there are many presumptive injuries and diseases for public safety. The fact that this has not been addressed yet is sad and needs to be fixed. Similar to those that sacrifice their health by serving in the military, duty belts take a huge toll on your hips and back. This leads into secondary injuries from the hip and back problems. Fortunately the military has a way to take care of those that get injured while serving but Virginia is lagging behind on this issue. In some ways politicians are responsible for law enforcement officers to have to carry more and more equipment on their person. This is getting so out of hand that some officers have items going around their entire waistline. I highly encourage the committee to step up and vote yes on this bill. It’s hard enough to recruit officers these days but maybe this will be a small showing to potential recruits that Virginia will do our best to look out for their wellbeing if they decide to serve the public. Thank you.

Comments Document

As the leading human rights organization for all individuals with Down syndrome, the National Down Syndrome Society (NDSS) strongly supports the passage of HB 1924, which would remove the exemption that allows individuals with disabilities to be paid less than the minimum wage.   Despite existing civil rights protections, thousands of Americans with disabilities are legally paid less than the minimum wage because of a provision in Section 14(c) of the Fair Labor Standards Act of 1938. Under 14(c) employers can apply for special certificates from the U.S. Department of Labor that allow them to undercut the minimum wage for employees with disabilities. According to a 2020 U.S. Commission on Civil Rights report, between 2017 and 2018 the average wage of a person with a disability working under such certificates was only $3.34 per hour. While the provision was originally intended to afford people with disabilities otherwise unavailable opportunities to work, after more than 80 years, the continued use of these 14(c) certificates is anachronistic and fails to recognize the rights of people with disabilities or value the contributions they make to their workplaces, communities, and American society in general.       By phasing out the use of subminimum wage, this bill affirms that employees with disabilities have the right to and ability to work in competitive integrated employment settings alongside their colleagues without disabilities and to be paid equitable wages for their work. 15 states have already taken legislative action to change this outdated and offensive law. Passage of HB 1924 will build on these efforts, eliminating disability wage discrimination in Virginia and influencing critical policy change in our country.       NDSS envisions a world in which all people with Down syndrome have the opportunity to enhance their quality of life, realize their life aspirations, and become valued members of welcoming communities. We urge the Virginia House of Delegates to take action to phase out subminimum wage for individuals with Down syndrome and other disabilities, and we thank you for your leadership regarding this important piece of legislation.    If you have any questions, please do not hesitate to contact our Manager of State Government Relations, Nick Leto, at nleto@ndss.org. Sincerely, Kandi Pickard President and CEO National Down Syndrome Society

I strongly support HB1924. People with disabilities have the same expenses as everybody else, and deserve fair pay just like everybody else.

Comments Document

Written testimony of Alexander Bolden, a disability advocate with Down syndrome.

I am pleased to support Delegate Hope's bill to phase out 14c and end subminimum wage for people with disabilities in Virgnia. All Virginian's that work should earn minimum wage or a wage commensurate with their peers for equal work. Please help stop this demeaning discriminatory practice against our most vulnerable citizens.

This bill is essential in ensuring each individual is paid minimum wage both for the sake of equality for all people as well as providing those individuals with a wage that is feasible to live on. As a Supported Employment Specialist, I have many clients whose wages are essential for them and their families. Making at least minimum wage is important not just because those individuals are doing real work and deserve real pay, but also because they and their families have many of the same financial obligations that anyone else has. With the state minimum wage increasing each year, it is crucial that we also ensure our clients' minimum wages are being raised as well.

Honestly, I’m surprised the 1930’s legislation is still on the books. I work with disabled people everyday and there expenses aren’t less than my own. They need a living wage just like the rest of us. Please help them help themselves.

I stand firmly against 14(c). As 14(c) targets only people with disabilities, it is, by definition, discriminatory. After 85 years in existence, now is the time for the Commonwealth of Virginia to correct this civil rights issue and end 14(c). Ending 14(c) will send a message to all people with disabilities, their families, and communities that their time in the workplace is valued.

Discrimination is defined as the unjust or prejudicial treatment of different categories of people, especially on the grounds of ethnicity, age, sex, or disability. Allowing employers to pay people with disabilities subminimum wages is discriminatory and illegal. All persons are valued and thus should be paid according to their work competence. This bill should be enacted to provide equality for all.

Hello, I work with adults with disabilities as a Job Coach. I get to facilitate eager, willing individuals find employment and fulfillment in our communities. These individuals are a valuable part of their organization and deserve to be compensated fairly for their time. I was surprised to learn that there is existing legislation that allows person's with a disability to be paid less than minimum wage. This is not right. I hope you will consider the people that this injustice is affecting, perhaps someone you know, and do the right thing; repeal this outdated piece of legislation from a dark time in our history. Every Virginian working deserves at least minimum wage. Thank you. Jeffrey Kinder

Comments Document

Letter is attached and explains that Didlake fully supports passing HB 1925 to eliminate the payment of subminimum wages to people with disabilities. Now is the time to do this and support in the form of almost $14 million was provided to the state of Virginia to ensure a proper phase out of the 14c certificate program can happen in the most supportive manner. Rachel Payne Didlake, Inc rpayne@didlake.org

Good afternoon, my name is Jewelyn Cosgrove and I’m pleased to speak today in support of H.B. 1924. I am the Vice President of Government and Public Relations at Melwood – a leading employer, advocate, and preferred service provider for people with disabilities. Melwood employs over 1600 employees on an annual basis throughout Virginia, Maryland and DC, nearly 1,000 of whom have significant disabilities. Years ago, Melwood voluntarily relinquished its 14(c) certificate that allowed us to pay subminimum wages for many years. We had to discontinue some of our lines of business because they were suddenly in the red. But we also stood up new pilot programs, transitioned employees into other fields and into new lines of business. We opened up new career paths that weren’t there before. Melwood employees who were once paid under 14c tell me they struggled with financial stability, that they were worried about paying their rent, affording their groceries, and supporting their families. Their workload would never change – but their pay would fall. Ending 14c at Melwood made us more innovative, more competitive, and improved our corporate culture and employee morale. If we are seeking a business environment that is innovative, fair, and productive, then 14c is a hinderance to those efforts. If we are seeking a workplace that fosters independence, self-sufficiency, and reduces reliance on public benefits, then 14c is a hinderance to those efforts. Workers with disabilities deserve the same dignity as any other worker. The continued practice of paying people with disabilities lower than any minimum wage reinforces the discriminatory premise that people with disabilities are not capable of doing much, that they don’t warrant investment, and that they aren’t going anywhere. It’s this bigotry of low expectations that foreshadows, and often directly causes, a life of poverty, segregation, and dependency on public support. The national and state trends are clear, and the federal grant received by DARS makes the timing all the more ideal and well-positioned to take this final step and eliminate the reference to the federal law still in Virginia Code. I urge you to vote yes today on H.B. 1924. Thank you for your time.

I support a bill that makes the disabled to have the same pay as another for the same work.

I am writing to express my full support of HB1924. Sheltered workshops, enclaves, and the justification of subminimum wage are an outdated and ableist perspective of people with disabilities, and their perceived limited contribution to society. Instead, we should be promoting and honoring the dignity of people with disabilities by providing community-based, integrated employment and pay that is commensurate with the pay of their peers without disabilities. Real work for real pay. Ending subminimum wage is simply the right thing to do. It is a civil rights issue that can lift people with disabilities out of poverty, and provide them with the means to participate more fully in society.

Dear Valued Legislators, There are less than 400 people in Virginia earning sub-minimum wage. The Department for Aging & Rehabilitative Services received a five year, $13.8m grant from the U.S. Department of Education’s Rehabilitation Services Administration to support the transition of people into competitive integrated employment. Virginia has the resources and community support to make this transition happen. Legislative action would send a message to all Virginians, but especially the disability community that their time at work is at least worth the minimum. Giving less than the minimum to people with disabilities is a civil rights issue. Please support this bill. Respectfully, Jason Harper

As an employee of an organization that provides services to individuals with disabilities as well as someone with family members who have disabilities, I do not support any law that allows for these individuals to be compensated at a lesser rate by employers. The disabled community makes up a greater percentage of Virginia’s workforce now than ever before. Individuals with disabilities perform the same job tasks as coworkers who do not have disabilities, and they should be compensated on a fair and equal basis.

Comments Document

NDSS letter of support for HB 1924

Disabled workers can be hard and kind hearted workers. They deserve better. The fact that some of them get $2 an hour is obscurd! They are human beings! It’s time for them to be treated as such.

ChildSavers is a 98-year-old nonprofit providing trauma-informed mental health services for children in Virginia. Current provider credentialing practices have a significant impact on our ability to address Virginia’s youth mental health crisis. This bill would clarify those processes and will result in increased access to mental health services for children in the Commonwealth.