The 2018 Congressional Budget and Tax Cuts – What It Could Mean for People with Disabilities and What We Must Do

The CapitolThis year’s Congressional budget process is particularly important for people with disabilities and their families. The recently-passed House and Senate fiscal year 2018 budgets set overall spending and revenue targets for the next 10 years. But beyond this basic function, Congressional budget writers have been clear that an underlying goal of the 2018 budget is to set the stage for a massive tax cut bill.  The Arc is concerned that significant loss of federal revenue will result in cuts to programs for people with disabilities

The Senate passed its Budget on October 19 and the House passed the same Senate Budget a week later. House Speaker Paul Ryan (R-WI) is aiming to pass a tax cut bill before Thanksgiving that, under budget rules, can be passed by a simple majority vote in the Senate. A great deal is at stake. Here’s what it could mean for people with disabilities, and what we must do.

What is in the Congressional Budget?

Congressional BudgetThe Budget allows for up to $1.5 trillion to be added to the deficit over 10 years. Congressional committees are now drafting tax cut legislation that does not have to be paid for unless it goes above $1.5 trillion. But if the cost of tax cut legislation goes above that amount, then any amount over that could come directly from cuts to Medicaid, Medicare and many other programs that are critical for people with disabilities. The Budget assumes, but does not require, some $5 trillion in spending cuts over 10 years, as well as optimistic projections of economic growth, to make up for lost tax revenue.

What Do We Know About the Proposed Tax Cuts?

While the tax cut legislation has not yet been developed, the tax plan framework released by President Trump and key Congressional leaders in September indicates that its benefits may be heavily tilted towards wealthy individuals and corporations. Several types of taxes that it proposes to eliminate or reduce are only paid by very wealthy households, such as the estate tax that is only paid by individuals with estates worth over $5.5 million. See The Arc’s statement on the tax framework.

What Will The Arc Be Watching Out For?

At this point there are many unknowns. Here are five things that The Arc will be watching out for:

  1. Cuts To Medicaid, Medicare, Supplemental Security Income (SSI) or Other Critical Programs To Pay For Tax Cuts. The Budget instructs the Senate Finance Committee and the House Ways and Means Committees to develop legislation. In addition to taxes, the Senate Finance Committee has jurisdiction over many critical programs, including Medicaid, Medicare, SSI, Temporary Assistance for Needy Families, Child Welfare Services, Maternal & Child Health, the Social Services Block Grant, the Independent Living Program, and more. Therefore, the Committee may choose to draft a bill that cuts any of these programs and this bill could be passed with only a simple majority (51 Senators, or 50 Senators plus the Vice President) in the Senate rather than the 60 votes that are usually needed.
  2. Loss of Revenue that Sets the Stage for Cuts to Essential Programs. The Senate Finance Committee and House Ways and Means Committees could also choose to draft bills that only contain tax cuts. As noted earlier, budget rules allow for tax cuts that could increase the federal deficit by up to $1.5 trillion. Many members of Congress who favor tax cuts also favor cuts to programs such as Medicaid and Medicare. The Arc is concerned that passing a large tax reform bill that increases the deficit will make it easy to justify spending cuts down the road.
  3. What Happens with Tax Breaks.

    Tax Expenditures that Benefit
    People with Disabilities:

    • Standard deduction for people who are blind
    • Architectural and Transportation Barrier Removal Deduction
    • Disabled Access Credit
    • Work Opportunity Tax Credit
    • Impairment-Related Work Expense Deduction
    • The Low-Income Housing Tax Credit
    • Achieving a Better Life (ABLE) Tax Advantaged Savings Accounts

    For many years, supporters of tax cuts have called for the elimination of certain tax expenditures, also called tax breaks. If certain tax breaks are eliminated, the argument goes, then tax rates can be lowered for most people. In other words, getting rid of some tax breaks can pay for the desired tax cuts. However, not all tax breaks are alike. In fact, there are numerous tax expenditures, which come in the form of credits, deductions, exclusions, exemptions, preferential rates, or deferrals of tax liability. These tax expenditures presently total $1.5 trillion. The Arc will advocate to maintain expenditures that benefit people with disabilities and their families and oppose the elimination of those that only affect the most prosperous.Additionally, The Arc will work to ensure that tax provisions that could be harmful to people with disabilities are not included. For instance, we oppose education tax credits that reduce federal revenues in order to subsidize education in private schools that are not bound by the Individuals with Disabilities Education Act (IDEA) to provide needed services.

  4. US MapBasic Fairness. We expect that changes to the tax code should primarily benefit the majority of people living in the U.S., namely those with low and middle incomes. Public opinion polls show that sentiment is shared broadly. 62% of Americans actually favor increasing taxes on the wealthy, according to the most recent Wall Street Journal poll. However, this does not appear to the case in the tax reform framework, with families in the lower rungs showing only slight gains. The top 1 percent of households, however, are projected to receive 80 percent of the tax cuts by 2027. Click on the map at right to see average tax changes by income group in each state under the proposed framework.
  5. Mainstream Economics – Real Numbers and Real Issues. Tax cuts should be based on generally accepted economic theory and methodology. The Arc is concerned that controversial methods, such as dynamic scoring, will be used to overstate the economic benefits of enacting tax cuts. We also know from recent and historic examples that tax cuts have often not yielded promised results and have instead resulted in increased deficts and harmful programs cuts. The Kansas tax cuts provide a cautionary tale.

For more information, see:

The Arc Condemns Federal Immigration Detainment of Rosamaria Hernandez

Washington, DC – The Arc released the following statement in response to the detainment of Rosamaria Hernandez, a ten-year-old child with cerebral palsy, who was stopped by federal immigration officials on her way to the hospital for emergency surgery, and detained upon her release from the hospital.

“The images of uniformed agents trying to stop a child from getting to the hospital and then standing outside her room while a child with a disability is having a medical crisis are just appalling and outrageous.

“Yet that’s what happened after Rosamaria Hernandez underwent emergency surgery. And now, she has been ripped away from her family, nearly ten years after she came to the United States when she was just three months old.

“We are better than this. Prioritizing the swift detention of a ten-year-old girl with cerebral palsy who is recovering from significant surgery is a grossly misplaced priority by our government.

“While Rosamaria is in this unjust situation, she must be provided with legal representation, due process protections, and reasonable accommodations that meet her needs as a person with a disability on U.S. soil,” said Peter Berns, CEO, The Arc.

 

The Arc advocates for and serves people with intellectual and developmental disabilities (I/DD), including Down syndrome, autism, Fetal Alcohol Spectrum Disorders, cerebral palsy and other diagnoses. The Arc has a network of over 650 chapters across the country promoting and protecting the human rights of people with I/DD and actively supporting their full inclusion and participation in the community throughout their lifetimes and without regard to diagnosis.

Congress Must Reauthorize CHIP Now with Bipartisan Support for Funding

The Arc supports the House of Representatives’ bipartisan policy agreement to extend the funding for the Children’s Health Insurance Program (CHIP). CHIP is critical to providing health insurance to over 9 million children in the United States and has helped to reduce the uninsured population of children to historic low levels. It is urgent that Congress act to extend the funding for CHIP before states exhaust current funding. If the program expires, states will be forced to send notifications to families about pending loss of health insurance coverage for their children. These notifications and the potential loss of health coverage will create anxiety and concern among families who depend on CHIP for affordable health insurance coverage.

The Arc is concerned that the House is preparing to move forward with bipartisan agreement on the policy but strong disagreement on provisions for how the bill will be paid for. On principle, The Arc does not support provisions that pay for bills that hurt Medicaid or Medicare beneficiaries or beneficiaries of other important programs when extending equally critical programs. We urge the House of Representatives to continue to seek provisions with bipartisan support to pay for the CHIP funding extension. It is critical that Congress act to maintain this program and ensure that children continue to have access to the health insurance they depend on.

The Arc and the Walmart Foundation: A Successful Year in Assisting People with Intellectual and Developmental Disabilities Find Jobs in the Community

A year ago, The Arc announced the exciting news that it had been awarded $245,000 by the Walmart Foundation to support workers with intellectual and developmental disabilities (I/DD) to enter the workforce. The Arc@Work, The Arc’s employment program, quickly got to work with chapters from around the country to make a dent in the unemployment rate for people with I/DD, one job placement at a time.

Shortly after acquiring the grant, The Arc awarded 16 of its chapters subgrants. Each grantee was then charged with developing innovative programs that place job-seekers with I/DD in competitive, integrated employment within their communities. Chapters included were UCP Seguin (IL); The Arc of the Midlands (SC); The Arc of Spokane (WA); The Arc of Anchorage (AK); The Arc of Montgomery County (MD); The Arc of El Paso (TX); The Arc of Monroe County (NY); St. Louis Arc (MO); The Arc of Chester County (PA); Berkshire County Arc (MA); Star, Inc. (CT); The Arc of North Carolina (NC); The Arc Davidson County and Greater Nashville (TN); VersAbility (VA); The Arc of Bristol County (MA); and ADEC (IN). By the end of the grant cycle, The Arc had reached and even surpassed many of the grant’s objectives. As of September 2017, nearly 480 workers with disabilities had secured employment at nearly 360 companies under the program. Additionally, nearly 1,240 individuals with I/DD had undergone training to better prepare them to enter the workforce. Several success stories emerged as the year progressed, including this one about a self-advocate named Danielle from The Arc of Monroe County in Rochester, New York:

When Danielle first began employment services, she exhibited low self-confidence. And throughout the job development process, Danielle struggled with social interactions ranging from phone calls to interviews. As she experienced her first career fair, job interview, and informal meetings with potential employers, her confidence started to grow.

Eventually Danielle received a call for an interview at a local senior facility that would result in a pivotal change in her life’s course. The day before she was scheduled to interview, Danielle and her employment specialist practiced interview questions. The following day, Danielle was stellar during the interview process and performed the best she ever had! Her employment specialist knew when they walked out of the building that she would be offered the job. Danielle was able to engage the interviewer in a funny story and her demeanor and the content of her answers were on point. The following week Danielle was offered a job!

Danielle has been working at the senior facility now for 10 months. Her transformation has been incredible. In late June, Danielle’s astounding professional and personal growth was recognized at an awards ceremony sponsored by The Arc of Monroe County.

Based on this year’s achievement, The Arc was awarded an additional round of funding this past spring. With this support, The Arc hopes to build upon the success it began in 2016.

Community Matters for ALL

By: Nicole Jorwic, Director of Rights Policy, The Arc of the United States

What is important to YOU about community living?

Share your story!

During the recent fights to save the Medicaid program from devastating cuts and fundamental restructuring, the home and community based services (HCBS) that individuals with disabilities and their families rely on were in greatest jeopardy. These services include everything from residential supports, day supports, and employment services, to personal attendant care. This is because under federal Medicaid law, HCBS are OPTIONAL while other services such as institutional services are MANDATORY. So if the cuts included in the recent health care bills would have made it down to the state level, HCBS would have been the first thing on the chopping block. This new reality would have been devastating to individuals and families.

Those HCBS dollars are the ones that, over the last several decades, have funded the desperately needed shift from institutional placements and segregated services for individuals with disabilities to a full life in their communities.

Community Matters!

I have been lucky in my life to be a part of a community that involved all individuals in every aspect of the community, including my brother Chris who has autism. Chris is 28, lives in Illinois and receives Home and Community Based Services through the Medicaid program to remain in the same community where he has lived his whole life.

Not only do HCBS benefit the individuals with disabilities who receive them to stay in their community, it benefits every community member. Because of the services that Chris receives he is able to live in his home, do things that he chooses during the day out in the community, interacting with people who do not have disabilities, and gets the support that he needs to communicate through typing. Chris has a full life, and Medicaid HCBS have made that possible. However, it is never lost on me that if Chris had been born 20 or 30 years earlier, his life would most likely look very different because of his significant level of needs. Chris would have languished in an institution, away from his family, friends and his COMMUNITY never learning to express his wants, insights and amazing sense of humor. This knowledge is why I feel so passionately about making life in the community a reality for all individuals with disabilities, no matter their level of need.

The disability community showed our strength during the fights to protect Medicaid, and now we must rise up again to show the importance of ensuring that HCBS dollars are spent in the community and not in settings that isolate individuals from interacting with all parts of their communities. We need to show that life in the community is possible for ALL! The best way to send that message is to share stories about why community matters in YOUR life, and what your life looks like in the community.

Chris has already written his own story and submitted it, please take a moment to do the same. You can enter your information here. We will use these stories to show the need to increase the investment in HCBS dollars and to ensure that capacity is built to support every individual in their communities.

Boston University Sargent College and The Arc of the United States Approved for $50,000 Funding Award by the Patient-Centered Outcomes Research Institute

(Boston) – Jessica Kramer, assistant professor of occupational therapy at Boston University College of Health & Rehabilitation: Sargent College and The Arc of the United States have been approved for a $50,000 funding award by the Patient-Centered Outcomes Research Institute (PCORI). The award will support a project identifying the mental health research priorities of young adults with intellectual and/or developmental disabilities (I/DD).

Kramer and The Arc will use the funds provided through PCORI’s Pipeline to Proposal Awards program to build a partnership of individuals and groups who share a desire to advance patient-centered outcomes research focused on finding optimal treatment approaches for young adults with I/DD. Self-Advocates Becoming Empowered (SABE) will also play a significant partnership role in this project.

Pipeline to Proposal Awards enable individuals and groups that are not typically involved in clinical research to develop the means to develop community-led funding proposals focused on patient-centered comparative effectiveness research (CER). Established by the non-profit PCORI, the program funds help individuals or groups build community partnerships, develop research capacity, and hone a comparative effectiveness research question that could become the basis of a research funding proposal to submit to PCORI or other health research funders.

This project will build a national partnership between young adults ages 18-30 with I/DD and their families, service providers, and researchers to identify mental health research priorities for young adults with I/DD. This partnership will seek consensus on mental health priorities and corresponding intervention needs for further exploration. Kramer and The Arc’s vision is to establish a sustainable partnership that is poised to engage in patient-driven mental health research that will improve support and facilitate the lifelong wellbeing of people with I/DD.

“The Pipeline to Proposal Awards program is a manifestation of PCORI’s commitment to the meaningful involvement of patients, caregivers, clinicians, and other stakeholders in all our research endeavors,” said Jean Slutsky, PA, MSPH, PCORI’s Chief Engagement and Dissemination Officer. “It provides support to those who may not otherwise have an opportunity to contribute to the field of comparative effectiveness research. We’re pleased to follow the awardees’ progress as they develop partnerships and begin to form research questions.”

PCORI is an independent, nonprofit organization authorized by Congress in 2010 to fund comparative effectiveness research that will provide patients, their caregivers, and clinicians with the evidence needed to make better-informed health and healthcare decisions. PCORI is committed to seeking input from a broad range of stakeholders to guide its work.

 

CONTACTS:

Boston University College of Health & Rehabilitation: Sargent College
Stephanie Rotondo, (617) 353-7476, rotondos@bu.edu

The Arc of the United States
Kristen McKiernan, (202) 534-3712, mckiernan@thearc.org

 

#####

 

Boston University LogoBoston University College of Health and Rehabilitation Sciences: Sargent College is an institution of higher education which fosters critical and innovative thinking to best serve the health care needs of society through academics, research, and clinical practice. As reported by U.S. News and World Report, its graduate programs in Speech-Language Pathology and Physical Therapy rank in the top 6% of programs while Occupational Therapy is #1 in the nation. The College has more than 25 on-campus research facilities and clinical centers and offers degree programs in occupational therapy, physical therapy, speech, language and hearing sciences, health science, athletic training, human physiology, behavior and health, and nutrition. For more information, visit bu.edu/sargent.

Founded in 1839, Boston University is an internationally recognized institution of higher education and research.  With more than 33,000 students, it is the fourth-largest independent university in the United States.  BU consists of 17 schools and colleges, along with a number of multi-disciplinary centers and institutes integral to the University’s research and teaching mission. In 2012, BU joined the Association of American Universities (AAU), a consortium of 62 leading research universities in the United States and Canada.

 

The Arc advocates for and serves people with I/DD, including Down syndrome, autism, Fetal Alcohol Spectrum Disorders, cerebral palsy and other diagnoses. The Arc has a network of more than 650 chapters across the country promoting and protecting the human rights of people with I/DD and actively supporting their full inclusion and participation in the community throughout their lifetimes and without regard to diagnosis.

The Arc Responds to Bipartisan Health Care Legislation

Washington, DC – The Arc released the following statement in response to Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA) releasing bipartisan health care legislation:

“The Arc commends Senators Lamar Alexander and Patty Murray for their bipartisan work on health care. Together they have developed legislation that continues the cost-sharing reduction payments that help low income people access affordable health insurance for two years. Stopping these payments raises concerns about insurers significantly raising premiums or dropping out of the market place. A short-term extension will help stabilize the market place.

“The Arc encourages Congress to continue to work in a bipartisan manner on health care issues. People’s lives are at stake and we need a solution that supports all citizens including people with intellectual and developmental disabilities and those with significant medical needs. We appreciate the leadership shown by Chairman Alexander and Ranking Member Murray of the Senate Health, Education, Labor and Pensions Committee,” said Peter V. Berns, CEO of The Arc.

The agreement that Senators Alexander and Murray announced would also partially restore federal funding to the Department of Health and Human Services for consumer outreach and education and enrollment assistance. These services, which were cut earlier this year, help people enroll and understand the different plan options available. Restoring funding for these programs will be critical to ensuring the expansion of health care coverage and to reduce the number of uninsured people.

The bill also makes changes to the Section 1332 state waiver process. Section 1332 was included in the Affordable Care Act (ACA) to give states the option to experiment with other health coverage models as long as they maintain access to high quality, affordable health care, and maintain the consumer protections in the ACA. The proposal would keep the consumer protections in Section 1332 but streamlines the administration of the waiver.

The Arc advocates for and serves people wit­­h intellectual and developmental disabilities (I/DD), including Down syndrome, autism, Fetal Alcohol Spectrum Disorders, cerebral palsy and other diagnoses. The Arc has a network of over 650 chapters across the country promoting and protecting the human rights of people with I/DD and actively supporting their full inclusion and participation in the community throughout their lifetimes and without regard to diagnosis.

No Rest for the Weary: Hurricane Harvey and Its Effects on People with Disabilities in Beaumont, Texas

by Hannah Colletti, The Arc of Greater Beaumont

People with Disabilities Affected by Hurricane Harvey

Some of the clients and providers staying at The Arc of Greater Beaumont pose for a picture in front of boxes of generous donations.

The flooding in Beaumont was unprecedented. Slowly, one by one, different sections of the city took on water. Some flooded during the days of seemingly ceaseless rain. Others flooded days after the storm, when the sun had finally come out, but when the bayous and rivers began to crest. Among the masses of those affected were people with disabilities. When one group home flooded, clients took shelter in another, until eventually a majority of homes had been damaged. Without a place to go, The Arc of Greater Beaumont offered refuge in their building. Chapter staff and their board scrambled to find air mattresses, pop up tables, and folding chairs to make people as comfortable as possible, as residents of five flooded group homes took refuge.

People saved what they could carry. John, a 21-year-old regular client of The Arc of Greater Beaumont with cerebral palsy, had a change of clothes, an extra pair of tennis shoes, a computer bag, a heat pack to help ease the recurring pain in his shoulder, and a single framed portrait of his family. He had lived in a group home in Bevil Oaks since December of last year, but unfortunately, it was almost completely underwater. Without a house to return to here in Beaumont, he feared he would be transferred to a home two hours away in Lufkin, which would put him farther from his family, his girlfriend, and his community.

The stress on clients and providers alike was palpable. Simple tasks like taking medicine became difficult due to the scarcity of water. No laundry facilities or showers were available, so providers were hand washing clothes and setting up sponge baths with what little water they could spare. Clients felt cramped. Though the space was accommodating, there was little more than a few feet between beds. Sleep was hard to come by for some, who were easily kept up by movement and noise.

Amidst the challenges, help came from our fellow chapters of The Arc from across the country, which sent supplies to help the Beaumont area. The Arc of Colorado, The Arc of Aurora, and The Arc Thrift Stores in Colorado crafted a plan to support The Arc of Greater Beaumont. Von Limbaugh, a member of The Arc of Colorado’s board of directors, reached out. Von and his son Andrew packed up a truck, loaded with 400 pounds of clothing from The Arc Thrift Stores, supplies from members of The Arc from across the state, water, food, baby supplies, medical supplies, cleaning supplies, and toiletries and they started to drive. Staff from chapters across the country were calling our executive director, offering anything to be helpful. We collected and organized donations and have been distributing them to those in need. The absence of a full kitchen made it hard to cook hot meals, yet still hot meals came from private individuals within the community. Board members for our chapter arrived with gallons of water and fresh produce. The organizations that ran the group homes did their best to fix and find spaces for their clients, and fortunately within a few days, everyone had a more stable solution to their housing needs.

Our community is still adjusting to the reality of life after this cataclysmic event. People with disabilities served by our chapter and the group homes are a part of this community figuring out how to recover. Their housing and day to day routine has changed greatly, and they’ve lost much of what has long been familiar to them. The Arc of Greater Beaumont has received numerous pleas to host events so these citizens can have a slight return to normalcy. Like any other non-profit or small business in our region, our bottom line has been impacted by this event. Thanks to the spirit of the greater Beaumont community, we have faith we will endure this hardship. And our hearts are full thanks to the generosity of our very special chapter network. We truly are a family.

President Trump Moves to Destabilize the Affordable Care Act (ACA)

The Arc is deeply disappointed by two recent initiatives of the Trump Administration regarding the Affordable Care Act (ACA). The first is the Administration’s decision to end cost sharing reduction (CSR) payments, a decision which will be devastating to the health insurance marketplace created by the ACA. CSRs were included in the ACA to help ensure that people earning less than 250% of the federal poverty level ($60,750 for a family of four in 2017) can afford out of pocket expenses such as deductibles and co-pays. The money is provided to the insurance companies to help them offer the required affordable coverage. CSRs are different from the premium tax credits also required by the ACA to help individuals and families afford the premiums. The tax credits are available to people earning up to 400% of the federal poverty level ($97,200 for a family of four in 2017).

Health insurers urged the Trump Administration to continue the payments to help keep premium costs down and to keep health insurers selling in the marketplace. The Congressional Budget Office estimated in August that ending the CSR payments would cost taxpayers $6 billion in 2018 and $21 billion in 2020. This is because the premium tax credits would go up when premiums are raised by insurers to offset the loss of the CSR. This move is consistent with the Trump Administration’s desire to undermine the ACA by driving more insurers out of the marketplace and discouraging people from signing up for coverage.

Last week the President also signed an executive order directing federal agencies to find ways to offer health insurance products that do not comply with the consumer protections in the ACA. These protections include ending pre-existing condition exclusions, ensuring that people with health conditions do not pay more, ensuring health plans cover adequate health care services, and other protections. These changes are particularly critical to people with chronic illness and disabilities who needs these protections to have access to affordable care that meets their needs. Promoting cheap and skimpy plans will hurt people who have more health care needs. It can also draw healthier people to the inadequate plans outside of the marketplace. These changes could make health insurance more expensive in the marketplace.

The executive order also directs agencies to figure out how to allow insurance plans to be sold across state lines. Currently health insurance plans are regulated on the state level. State insurance commissions are responsible for ensuring that the insurance sold in the state is sold by reputable and financially secure companies and meet the insurance requirements in the state. This type of change would bypass the state insurance commissions in addition to allowing plans that do not include the ACA protections.

The executive order does not immediately make these policy changes but directs the agencies to find ways to do so. These policy changes are in addition to the Trump Administration’s decisions to shorten open enrollment, slash advertising about open enrollment, shut down the healthcare.gov website for periods of time during open enrollment, and slash funding for health care navigators who help people with questions. Together these actions create additional barriers to enrollment.

The newest changes in the executive order and relating to the CSRs will depress enrollment, increase costs, and be particularly harmful to people with chronic illness and disabilities. The changes do nothing to improve access to affordable health care. Instead, it is expected that people with pre-existing conditions will be paying more for less in a destabilized health insurance marketplace.

The Arc Responds to President Trump’s Health Care Executive Order “Extremely dangerous for people with disabilities”

Washington, DC – The Arc released the following statement in response to President Trump’s Executive Order Promoting Healthcare Choice and Competition Across the United States

“President Trump, through the new Executive Order “Promoting Healthcare Choice and Competition Across the United States”, is urging his Administration to find ways to circumvent critical protections of the Affordable Care Act including pre-existing condition protections and requirements for adequate health benefits. If the agencies implement this order, it would undermine the health insurance marketplace and drive up the costs of premiums for people with chronic illnesses and disabilities. This is extremely dangerous for people with disabilities who have relied on the Affordable Care Act to receive quality and affordable health care. The Arc vehemently opposes health care policies, like this, that are detrimental to people with intellectual and developmental disabilities.”  said Peter Berns, CEO of The Arc.