Alvaro Gutierrez: Hello and welcome to Project Access for All. Today, we have with us, Peter Thomas. He’s a principal at the Powers Law Firm in Washington, DC. We’re gonna talk to him about healthcare. We’re gonna talk about disability law and legislation, and it’s going to be a very interesting conversation. Thank you Peter for being with us today.

Peter Thomas: Thank you, I look forward to it.

Alvaro Gutierrez: My pleasure, and the first question is can you tell us briefly about your life?

Peter Thomas: Sure, well, I was born and raised in Long Island, New York. And at age 10, I was involved in a car accident. Lost both my legs below the knees, and unfortunately, my eight year old brother was killed in the same car accident. I was sent to Craig Rehabilitation Hospital in Denver, Colorado, and received about two and a half months of in-patient rehabilitation, and wound up walking into my fifth grade class. And since then—I’m 51 now—I’ve had 13 sets of artificial limbs over the years and have really devoted my life to disability and rehabilitation advocacy. I went to law school, went to Boston College, and then law school at Georgetown University Law Center, and wound up in Washington, DC., and became really an advocate, doing legal representation and legislative and regulatory work on behalf of rehabilitation and disability interests, whether it’s patients, providers, really the community of rehab and disability. I’m married. I have a beautiful wife and three children, three boys. And I love what I do.

Alvaro Gutierrez: (chuckles) That says it all for our listeners. What can you tell us about the Powers Law Firm?

Peter Thomas: Well, the firm began in 1983, had a big merger in 1992, which is when I ultimately joined the firm, and became a principal in the firm in 1998. The firm focuses on healthcare and education. Many law firms are very diverse and try to do a lot of different things. We’re a fairly small firm. We have 45 lawyers, which by and large, these days is a relatively medium or small firm. We’re solely focused in Washington. In other words, we don’t have satellite offices all over the country or all over the world. But we do have a national practice, so we serve clients in every state of the union and have a very robust healthcare and education practice. Those two areas happen to be very similar, with respect to interaction with the government. They’re heavily financed by the government, heavily subsidized. They come with a lot of federal regulations, and there’s a lot of activity from a legislative and regulatory and legal perspective in both of those fields.

Alvaro Gutierrez: Now, for our listeners, I found a term that is very interesting for us to learn about; disability law. Can you explain what is that?

Peter Thomas: Sure, well, there’s a number of different aspects to it. The type of law that we do that relates to disability really consists of representing both people with disabilities and associations, or organizations, of people with disabilities. So, for instance, the Brain Injury Association of America, or the Amputee Coalition, or other types of, you know, condition-specific or broad-based disability groups, and working in coalitions to forward the message and advance the message, whether it be in healthcare, or civil rights, or employment, or any number of different areas. I tend to focus on, not only healthcare, but in the subspecialty of rehabilitation and disability-related issues, so what happens to a person after they receive a traumatic injury, or after they have a significant illness or injury, and all the policy implications that come with that. Do they have access to providers, can they get—can those providers get
adequate reimbursement and coverage for the services they provide, can the patient get a coordinated and intensive rehabilitation program, or are they sent, you know, to a lesser setting of care, and essentially, not take advantage of all the good healthcare that this system has to offer. So that’s primarily what I do. I focus on trying to really give back the same level, or better level, of healthcare access that I had myself growing up.

Alvaro Gutierrez: How important is that, and I think many people don’t have this kind of knowledge that, you know, firms like yours exist. I know people in the United States that tell me, “I wish there was a way,” and there is a way to find out what to do next. And that is very important to raise awareness about what you are doing.

Peter Thomas: Well, it is, and there are some specialty firms like mine and there are others like myself that do this kind of work. Many people work in associations, or other non-profit organizations or foundations. Others volunteer their time and donate their time for good causes. I have happened to figure out a way to, you know, be schooled in the law, and then take that education and training and apply it to something that means a great deal to me personally, and really focus in on a particular area that is rehabilitation and disability. And, you know, I’m no saint, I make a living doing this, I pay the bills doing this, but I also happen to believe that the work that I do and a lot of others in the firm do, you know, adds value and really does help people with disabilities. At least that’s the goal.

Alvaro Gutierrez: Now, many people think, “Okay, what kind of healthcare services do I have access to in Washington?” For instance, what would you say to people with disabilities who don’t know what options do they have, because, as you very well know, Peter, your healthcare system is complex. I mean, you have a country of over 300 million people, you have 50 states, you have a lot of, how you say, relations and this and that and the other, and compared to
many other countries, it’s very complex to understand, and even people living there don’t know what they have access to. What can we tell them?

Peter Thomas: Well, first off, you’re absolutely right. It’s a very complex system. I guess, in some respects, that enables me to do what I do, is to try to take that complexity and interpret it, understand it, and then convey to others, who may not have—may not spend as much time, examining the health system as I do. So that’s kind of provided me with an opportunity to really focus in this area in a very meaningful way. The US healthcare system, I mean, this is—(chuckles) the answer to this question can go on and on, but I’ll try to make it as concise as possible. The US healthcare system is very fragmented. There are numerous programs and payers that ultimately provide healthcare coverage to finance healthcare in this country. And yeah, there’s still millions of people without any healthcare coverage whatsoever. So when those people have a significant health condition, whether it be an accident or an illness, they really are at risk. There are laws in the United States that no emergency room can turn you away just because you don’t have the ability to pay. So it’s not as though people are dying in the streets by any means, but the fact is that the US healthcare system does have those who can afford coverage and afford to pay the bill, and it has people that can’t. And it’s a mix, kind of a patchwork, of different programs, heavily federally subsidized, and various programs that segment the marketplace, if you will. So for instance, you’ve got a veterans system that serves veterans, you got the Medicare program that serves seniors over age 65 and people below 65 who have disabilities, you got the Medicaid program, which serves the low-income population that can’t really afford coverage. And then you’ve got the employer-based system, and now the Affordable Care Act offers the whole range of new marketplaces for healthcare coverage for individuals or small groups that aren’t necessarily tied to an employer, but still need coverage
nonetheless. So it’s a—it is a complex system, but you know, it’s an interesting thing. There’s some of the best healthcare in the world in the United States, and yet, it’s not evenly distributed. There’s a lot of people who simply don’t have access to good quality care.

Alvaro Gutierrez: For someone listening in Washington, or somewhere else in the country, what would you recommend them to do first to see what is best for their case? What kind of health system services is better for them?

Peter Thomas: Well, if they’re in the United States, they’re either gonna be uninsured and have no coverage at all, or they’ll be eligible to be insured in a program, for instance, Medicaid, or to receive some federal subsidies to purchase private insurance through Affordable Care Act plans. You know, the Affordable Care Act is the major health reform law that passed in 2010 that largely went into effect in 2014. So ultimately—and then there’s a number of people who are also qualified for coverage based on age or their service to the country, veterans for instance, so if they have coverage, the real question is finding out what the benefits are, what’s covered, and what do they need. And by and large, people through these coverage plans usually have pretty good access to healthcare. Now, it may cost them something and the cost of healthcare out of pocket for many individuals across the country in various programs has tended to go up over the years, and that’s obviously something of a major concern when you’re talking about people with fixed incomes and the like. But there are a patchwork of programs and safety-knit programs to cover those who don’t have coverage. So it’s a difficult question to answer with a very specific statement.

Alvaro Gutierrez: Now, we all follow the—President Obama has the reforms, and he has been promoting and these preexisting conditions part. My question to you is does that mean that if someone is visually impaired and he has a risk of getting a retinal detachment, for instance, if
you go to a healthcare provider, it will have to accept your preexisting condition because of this, or how is that?

Peter Thomas: Well, that is probably the, the largest and most significant change that occurred in 2010 with passage of the Affordable Care Act. Prior to 2000—well, actually, it took effect in 2014—so, prior to 2014, the insurance market, the private insurance market, you know, the Aetnas, the Blue Crosses, and the US healthcares of the world, routinely discriminated based on health condition, claims experience; that was permissible. That was legal. I used the word discrimination, it was not illegal discrimination. It was permissible, or legal discrimination, to look at someone’s claim status and how healthy they were and to base their premium payment for what it would take to insure them, based on that health status. So routinely, insurance companies would look at people’s medical records and examine whether they had a heart condition, or whether they were obese, or whether they sought a psychotherapist multiple times over a two year period, whatever, and they would base their premium for what the person would be paying for that coverage, based on that experience. Sometimes they’d say, “Sorry, you’re not insurable at all, we won’t offer you insurance.” That all went away in 2014. So the biggest change that the Affordable Care Act brought was to prohibit discrimination based on health status, so now when you go to the private insurance market and you want to purchase a plan, a healthcare plan, to cover you, the insurance companies cannot ask you what your claims experience is, what your health condition is. They’re prohibited from doing so. And they can only rate your premium based on a series of factors that largely have nothing to do with health status. You know, they’ll say what is your age, they can ask you your age obviously, and they can base the premium based on whether you’re an individual, or whether you’re buying coverage for your family. But they really can’t say, “Well, you’re a smoker,” well actually,
the smoking part of it, they do allow you to adjust the premium based on smoking status as well, but they cannot say, “You’ve had a heart attack five years ago, and so your premium’s going to be twice or three times what the next person’s is.” They can’t do that. And they must guarantee you access to coverage, so if you are ready to pay the premium, they have to offer it to you. They can’t rescind it, they can’t—they must renew it if you choose to continue to pay the premiums. They can’t impose a lifetime cap, or an annual cap, on your benefits, there are—and they can’t impose preexisting condition exclusions. So there’s a whole, huge array of guarantees to coverage that are now in place that weren’t in place prior to 2014.

Alvaro Gutierrez: That was very, very important, yes.

Peter Thomas: Yes, it was.

Alvaro Gutierrez: Now, this may sound a little bit controversial to our listeners, and this I don’t have written here, I hope (chuckles) it’s gonna be a, a good question, but it’s something that I have in my mind, Peter, now that we are discussing this subject. And it’s related to—I did an interview with a blind person in New Zealand, and he told me that in New Zealand, it’s one of the few countries in the world where you can have access to the government, tech for disabilities, and also be able to work whatever you wanna do, whatever time you wanna do. Both are okay. Both are legal. But as you know, in the US, there’s maybe a way to get your disability check and get some kind of work, but there are many restrictions, as well. I have friends who tell me, “I am not able to make over this amount, because I’m getting disability check.” The problem is, I may need both. What do you say to that?

Peter Thomas: Well, it’s a—it’s a very difficult problem in the US. There’s a very strong sense that if you’re drawing government benefits, that you shouldn’t be able to work and make an income over a certain amount of dollars. To put it another way, if you’re able to make an
income and work, you shouldn’t be drawing government benefits. That’s a pretty strongly held view. The problem is that once people get on government benefits because of a disabling condition, they tend to never go off because they tend to simply not return to the work force and continue to draw government benefits. Now, those benefits are not rich, they’re not very high in terms of the dollar amount that the government sends that person each month. But they are enough, in many instances, to get through, in addition to other programs that might supplement that income, or food stamps, or other kinds of government programs. But we’ve got to figure out—there was very significant efforts, there were significant efforts in the past to impact that situation; something called the Ticket to Work program, which was specifically designed to get people off of government benefits if they were able to go back to work over time. That’s had varying levels of success. They continue to work to improve the program, and to get more and more people who are able to return to work eventually to go back into the workforce. But the part of the problem is the link to Medicaid coverage, because if you get access to disability insurance benefits, in other words, income, supplementary income, to the federal government, you typically will get covered by Medicaid through your healthcare. And so if you go back into the workforce, you stand to lose Medicaid coverage. That was also addressed in some legislation, but the jury’s out as to whether it’s really enough of an incentive to get people off of benefits once they join that program.

Alvaro Gutierrez: Now, the famous ADA, Americans With Disabilities Act, turns 25 this year. Can you give us your thoughts about the best, and still things that need to be improved, in this legislation?

Peter Thomas: Well, the ADA was landmark legislation back in 1990. It addressed non-discrimination based on disability in employment and state and local government services and
places of public accommodation. That’s everything from Starbucks Coffee to Stop and Shop grocery store, as well as telecommunications. What it didn’t address was health insurance, and in some respects, the Affordable Care Act, passed in 2010, is the final chapter of the Americans With Disabilities Act, which passed in 1990. Because it really does prohibit discrimination based on health status and addresses the whole area of discrimination-based health insurance coverage. So that is a huge development. The real question is how is the ADA 25 years after its passage, how is it doing? I mean, I’ve noticed just as an individual, incredible changes in how society views people with disabilities, in general access that people have to services and programs across the board, people with all types of disabilities. And yet, there’s clearly more room for improvement. I was recently—I had an operation recently on my leg to do some clean-up work and wound up in a scooter for about six weeks with a pair of crutches. And I found it very difficult to get around. I happened to be traveling and I went down to New Orleans. New Orleans is a historic town. There are many places in that city that are not accessible at all. Same with the more urban centers, like Washington, DC. and New York and etcetera, you’re going to have much more access. But there’s a lot of places across this country that simply haven’t done enough to comply with the ADA, even though it was passed 25 years ago. So there’s still work to be done, not only in physical access, but employment coverage. You know, people with disabilities still have a much higher unemployment rate than people without disabilities, so there’s still work to be done, there’s no doubt. But overall, it was an incredibly important law and one that has been replicated by countries across the world.

Alvaro Gutierrez: Now, let’s talk about the UN convention on the rights for people with disabilities. I have a question there for our listeners. I made many interviews with people that tells me this convention, this UN convention, is important for the US to sign into law and to, so
to speak, become like another brother to the ADA if you wish, because they were telling me the problem we face today is that if we go abroad, if we go to Europe for instance, we are not covered by the ADA, but we will be covered by the UN convention, and we don’t understand that in some of the people that are blocking these is people that don’t understand that, because they say the UN is gonna take over the United States law and that’s why we don’t want it, and that is absurd. Can you tell us about that and how optimistic are you about this?

Peter Thomas: Well, I like to remain optimistic, I sure hope the UN convention passes eventually. I think last year was a real disappointment, profound disappointment, when the law went to the Senate floor, and Senator Bob Dole, in a wheelchair, was on the floor of the Senate, having returned after, you know, after 30 years of service, to champion the passage of the treaty, and ultimately, it failed in the Senate. It’s unconscionable that the United States has not signed on to that treaty. The treaty essentially is very consistent with what is an outgrowth of the Americans With Disabilities Act, so it’s not as though the United States is going to be, you know, required to do all kinds of things that the ADA doesn’t already require it to do, but it would really set precedent across the world for people with disabilities to have greater access to opportunities today. You know, there’s plenty of countries who have begun to comply with ADA, like requirements, and are doing that on their own, but there’s also many countries who haven’t even come close. So this would be an incredible step forward across the globe to ratify it, to get this treaty fully implemented, and the fact that the United States is one—one of the only countries that has not approved it and gone forward, it really is a black mark on our history and I certainly hope that the US Senate sees the light of day and passes this treaty and ratifies it as soon as possible.

Alvaro Gutierrez: I have to say for our listeners, I totally agree, and I know our listeners agree all
the way. Now something very interesting, the Powers Law Firm is an equally opportunity employer; can you tell us what is that?

Peter Thomas: Well, that simply means that we’re held to, and hold ourselves to, the standards required by law that we do not discriminate based on a whole variety of factors required by the US Constitution and by the federal law. And so, we do not hire based on age, or gender, or disability status, or any other prohibited factor. So, anyone that comes to the door that is looking for a position, if they have the qualifications for the position, they’ll interview, we will do whatever we have to do to make reasonable accommodations to ensure that they can perform what they call the essential functions of the job, and if they are the highest qualified candidate, they get the job, regardless of their—of any factor or trait that they may possess. And frankly, that’s what equal opportunity means and every employer across the country is held to that, and we’re certainly in that (inaudible 25:47) and go overboard and bend over backward to make sure that no discrimination hiring ever occurs.

Alvaro Gutierrez: Peter, that makes me ask a follow-up, and it’s this; every company, every organization in the United States has to apply to this?

Peter Thomas: That’s correct.

Alvaro Gutierrez: So, my question is, why are many people with disabilities afraid of going into interviews and saying, “I have a disability.”?

Peter Thomas: Well, I guess what I would say about that is that’s every individual’s decision, whether they want to disclose that or not. And I, I should say that while every employer is held to that standard, it’s very difficult to prove that standard. It’s very difficult to prove when an individual is selected over another, who may have very similar traits and qualifications for a particular job, but one has a disabling condition that that employer fears will drive up his or her
healthcare costs. Maybe they fear that the individual won’t be able to perform as well as the other, just based on physical ability. Now, there are, truth be told, there are certain jobs that do require a certain level of physical skill and physical prowess, and when those traits are listed as an essential function of the job, a person with a disability that can’t perform them is not qualified for that job. So it doesn’t, it’s not a law, the ADA is not a law, equal opportunity law does not require employers to hire unqualified personnel; it’s simply make sure that their trait, their disabling condition, or their age, or their gender, or whatever it may be, is not the deciding factor, as to whether they get the job that someone else—that they don’t get the job that someone else does. You know, people with disabilities should decide what they need to say when they need to say it. When you’re going in for a job interview, you never, in my view, put your disability out there unless it’s obvious, and you want to talk about it as part of your—frankly, these days, sometimes wearing your disability on your sleeve can be a positive thing. The fact is that you’ve overcome more than the average person has had to deal with. That shows real strength in a candidate and in an applicant, and so, every situation is different, but once the job is offered to the person, then that individual, if they need an accommodation of some kind, can, under the law, raise their disability and request a reasonable accommodation. That’s usually how it works.

Alvaro Gutierrez: Now, we have companies in technology helping making their products accessible, their applications, and their services, but what we find is that, I have found as someone who is legally blind, is that, companies that have done very well, then they go a little bit backwards, and so, you have, for instance, an operating system in a particular phone that is working well with accessibility feature. And then, when they release the new one, when they update it, then accessibility goes down. My question to you, Peter, is we want a world where
everything is accessible for all. This is not only good for us, people with disabilities, but for everybody. It’s important for organizations and companies, because they make more money. We are consumers, as well. How can we ensure that companies don’t go backwards, and we have to call them all the time or email them and say, “Hey, you forgot to make this accessible for us after you made it accessibility a year ago.” It doesn’t make sense for us to do that. We need to make things accessible from the beginning as a business standpoint. It’s not only for us, but for everybody. What would you say to that?

Peter Thomas: Well, I couldn’t agree more, and as someone who has recently taken up bicycle riding, I’ll ride down the street and I benefit just as much as anyone in a wheelchair from curb cuts that have been included at every corner. And so, that’s just one small, probably silly, example of how universal design, if you will, designing architecture, designing buildings, designing road ways and sidewalks, and the like, so that everyone can use them. Whether it’s a mother with a stroller, or a bicyclist, or a, you know, a person with a spinal cord injury in a wheelchair or a scooter, the fact is designing things in a universal manner is going to appeal to and benefit everyone. And it’s the exact same with products, product development. There’s so many people who are taking advantage now of the technology where you speak and that speech is converted to text. That had its inception with accessibility features with people with disabilities, but it’s extraordinarily useful, and it’s used by millions and millions of users of smartphones across the country and probably across the world, so universal design and designing for everyone’s use from the start, and then maintaining that is absolutely critical. Why companies follow the edge and decide not to continue to be focused on that is beyond me. It’s in their financial interests to do so.

Alvaro Gutierrez: Now, as we all know, we have improved situation in becoming more and more
an inclusive society, but we have long ways still to go. But my question for you is not, I would say the obvious one, but how do you see is today the conversation between a person without a disability, with a disability, in order to connect with each other and work better together in this world. We are in the same boat and I’m gonna give you an example. If I go into the subway in New York—when I visit New York, I do that all the time—I find that people want to help me a lot, and for our listeners, I have to say about that about New Yorkers, they help a lot more than they get credit for. But what would happen, Peter, if not only they wanted to help me, but they also wanted to get to know me. And I’m gonna give you a good example. Someone sees me that I’m going to, getting to the subway, and they say, “Do you need help?” and I say, “Okay, yes, I need help to sit down.” Okay, so they help me sit down, and then what happens 90% of the time I have lived is, “Have a great day.” What would happen, for our listeners, if that person, after helping me, would say, “Listen, what do you do? What do you do for a living?” and would start a conversation beyond my disability. What would you say to that, Peter?

Peter Thomas: I think that would be a great world to live in. (chuckles) I do think that there are people who are really confused about how to interact with people with disabilities, and it’s just a person with a difference, that’s all. I mean, whether it’s, you know, whether you’re a person with a disability, or whether you, a person with different color skin, or a person who dresses oddly, or a person with tattoos and piercings, I mean, the fact is, people other than yourself always present questions about how to deal with them, and yet, if you engage people more often than not, they’re surprisingly nice and good, personable, nice people, so my guess is that folks don’t engage—if they’re not going to engage a person with a disability, it’s more because they just don’t know whether it’s the right thing to do. They don’t know quite how to approach the situation. They don’t want to offend anyone. I mean, I also know situations where people
have tried to help individuals with disabilities do certain things, and those people are quite proud and they don’t want help, and after a while of being asked if they need help and they don’t want it, they may snap at them. They may say, “No, I don’t want help, no thanks, I’m good, no, I’m fine.” So, you know, you get that reaction once or twice, and now as a (inaudible 35:26) person without a disabling condition, you’re not quite sure what to do, so I’m not sure if I blame those folks at all. I think I would probably, as a person with a disability, just do my best to be as outgoing as possible and to break down those barriers and do all you can to be open to those conversations and interactions.

Alvaro Gutierrez: Now, my final question, what would be your advice to anyone listening to us who are thinking, “Oh, I need some legal advice, but because of my disability, I may get in trouble, what are people gonna think?” What would you say to that?

Peter Thomas: Well, you know, I, I’m an attorney and so I speak on behalf of other people, and I try to advance people’s rights and so, I certainly believe that when someone has the law on their side, or when someone has been wronged, that they have a right to speak out and they have a right to correct the wrong. Or frankly, in some egregious situations, to be compensated for the wrong. That’s just fairness and equity, and there’s nothing wrong with that. I don’t put a lot of stock in retaliation. I don’t think there are many instances when people come to me and they’ll ask for assistance with, you know, a regulatory problem or a legislative problem and they’ll worry if they go up to Congress, that maybe, you know, the federal government is going to come after them and call the IRS on them or something like that. Number one, that’s illegal. Number two, it very, very, very, rarely happens, and in those instances where it has, it’s national news. It’s a scandal. So I really don’t put a lot of stock in not taking advantage of your rights when you know you’re right, and you know that the law’s on your side and that’s what
the system is designed to do. It’s designed to level the playing field, and for people not to have their rights run over without giving them some access to fight back. It doesn’t always have to be a negative interaction. It doesn’t have to be kind of a greedy thing. “I’m going to sue everyone I can,” that’s not what I’m talking about. I’m talking about righting wrongs and availing yourself to assistance and doing so if you feel that that’s the right thing to do.

Alvaro Gutierrez: So Peter, tell us how can people reach out for the Powers Law Firm?

Peter Thomas: Well, Powers is a Washington, DC.-based law firm. My email address is peter.thomas@ppsv.com. That’s peter-peter-sam-victor.com. We could be found on the web at www.ppsv.com, and our general phone number is 202-466-6550.

Alvaro Gutierrez: Peter, has a pleasure—has been a pleasure of having you on, and I think you have given us a lot of useful and new information.

Peter Thomas: Thank you for—I really enjoyed it, thanks so much for inviting me.

Alvaro Gutierrez: My pleasure Peter, and for our listeners, remember you can like us on Facebook at Project Access for All. You can follow us on Twitter @ProjectAccessForAll, and you can visit our website www.projectaccessforall.org. And if you want to be on the show, you can email us to podcast@projectaccessforall.org. So from Alvaro, from ABS and Project Access for All, thank you so much for listening to the show and have a wonderful day.