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Work Incentives Improvement Act Update: House Subcommittee Approves HR 1180, Next Stop Full Commerce Committee

Chris Marshall
For Immediate Release
21 Apr 99

By a unanimous vote, the House Commerce Health Subcommittee on April 20th favorably reported the Work Incentives Improvement Act (HR 1180/S 331), setting the stage for action by the full Commerce Committee within the next few weeks. As readers of the NAMI E-News know, this important bipartisan legislation would reform the SSI, SSDI, Medicaid and Medicare programs to make it easier for adults with severe disabilities (including adults with severe mental illnesses) to go to work without losing health care benefits under Medicare and Medicaid. HR 1180/S 331 also contains the "Ticket to Independence" program that would allow SSI and SSDI beneficiaries to use a voucher to select their own employment or psychosocial rehabilitation provider (outside of the current public vocational rehabilitation monopoly). It is authored by Representatives Rick Lazio (R-NY) and Henry Waxman (D-CA), as well as Senators Jeffords (R-VT), Kennedy (D-MA), Roth (R-DE) and Moynihan (D-NY),

The Commerce Health Subcommittee is the first committee in the House to act on the Work Incentives Improvement Act. The bill received a significant boost last month when Subcommittee Chairman Mike Bilirakis (R-FL) and full Commerce Committee Chairman Tom Bliley (R-VA) agreed to sign on as cosponsors. Their leadership on this issue has already proven critically important. Because HR 1180 cuts across so many different federal programs (SSI, SSDI, Medicare and Medicaid), the bill has also been referred to the House Ways and Means Committee, which is yet to act. Since HR 1180 already has 92 cosponsors, momentum is continuing to build for quick action by both committees and the full House.

By contrast, in the Senate, the Finance Committee has sole jurisdiction over the bill and has already favorably approved it. The next step in the Senate is floor action, where Majority Leader Trent Lott (R-MS) has yet to schedule a vote. Since the bill now has 74 cosponsors, pressure has already begun building on the Majority Leader to bring the bill up and ensure that the Senate moves quickly on this important, bipartisan legislation.


NAMI advocates are urged to continue the push for action on the Work Incentives Improvement Act. Despite strong support from the White House and key congressional leaders, HR 1180/S331 still has a long way to go. The following actions are needed:

1. Contact Senate Majority Leader Trent Lott and Majority Whip Don Nickles and urge them to call up S 331 immediately,

2. Contact House members - particularly members of the Commerce and Ways and Means Committees -- and urge them to cosponsor HR 1180. If they are already cosponsors, urge them to contact House Speaker Dennis Hastert in order to push for quick action by the full House,

3. Continue NAMI's efforts to thank key congressional leaders that have played such a key role bringing this legislation forward: Representatives Lazio, Waxman, Bilirakis, Bliley and Dingell and Senators Jeffords, Kennedy, Roth and Moynihan.

All members of Congress can be reached through the Capital Switchboard (202-224-3121) or through the NAMI website at


As many NAMI members know from personal experience, the current Social Security disability programs create numerous barriers for persons who, despite having found effective treatment that allows them to function at a higher level, want to work. Not only do SSDI beneficiaries (and persons who are dually eligible for SSI and SSDI) risk losing their cash benefits entirely, they also face the threat of losing health coverage for Medicare and Medicaid. In addition, many SSDI recipients find that Medicare coverage fails to meet all of their health care needs because of the absence of an outpatient prescription drug benefit in the program. HR 1180/S 331 is intended to change all of this by extending health coverage and establishing a new flexible consumer-oriented program called the "Ticket to Independence."

Specifically, the bill includes:

1) continued access to Medicare Part A and Part B for working SSDI beneficiaries, regardless of earned income, by paying only the Part B premium;

2) a new state program to provide complete Medicaid coverage, including outpatient prescription drugs, to SSDI beneficiaries who earn over 250% of the federal poverty level (the 1997 Balanced Budget Act extended a Medicaid option to states for persons making up to 250% of poverty);

3) a new "expedited re-entry" program that will allow individuals with episodic disabilities (such as severe mental illness) to immediately return to SSI and SSDI cash benefits if a short-term acute break forces them to leave a job;

4) a prohibition against Social Security using work as evidence of medical improvement as part of a Continuing Disability Review (CDR) for SSDI beneficiaries and dual eligibles;

5) creation of a "ticket to independence" voucher that allows all SSI and SSDI beneficiaries to choose the employment and rehabilitation provider of their choice and ensures access to supports and services designed to keep them in the workforce for up to 5 years (use of a "ticket" would stop unscheduled CDRs);

6) a new "Work Incentive Planning Assistance and Outreach" program to help beneficiaries navigate the complicated and often conflicting system of Social Security's work incentive programs; and

7) a requirement for Social Security to conduct a demonstration project to establish a sliding-scale cash offset in the SSDI cash program that is similar to the SSI cash program.