Many people with functional limitations cannot afford the AT they need. Public and private systems frequently do not create an efficient, market-driven approach to AT purchasing. A more extensive and coordinated approach to creating a universally accessible system for timely procurement, distribution and cost savings is needed. One element of the federal effort to advance the use of AT is the AT Act. The AT Act offers state-level support and advocacy for people with disabilities, provides information about AT, training for professionals, public awareness and assistance with securing funding. It addresses some of the most critical service delivery gaps identified in our research.

The Task Force supports the provisions of the AT Act. The goals of the AT Act can be substantially strengthened, including close cooperation with industry and the expansion of existing equipment distribution programs. In cases where none now exist, new ones that can be created are modeled after the very successful program in Missouri, which is funded by a nine cent surcharge on each phone call (see sidebar).

In the accessible nation envisioned by the Task Force, people with disabilities will purchase technology in an expanded, reorganized and consumer-driven process that takes advantage of scale. Some of the challenges inherent in this vision include, continuing the interagency coordination effort for greater compatibility among them, facilitating consumer informed choice, reducing the cost of AT and ensuring affordable access to emerging technologies. The overriding challenge is to make AT more affordable to those who need it and reduce costs to consumers, government, private insurers and taxpayers.

The High Cost of AT

Although not all AT is expensive, costs rise dramatically with the degree of sophistication and customization. A Plexiglas key guard, which covers a keyboard and permits people to type more accurately, costs approximately $100. At the higher end of the spectrum, augmentative communication devices that enable non-vocal students to express themselves range from $6,400 to $7,500. Local school districts often purchase this equipment. Additional costs are incurred to program some units so users may say what they wish to communicate in different settings such as a classroom, lunch room, restroom and at home.

Affordability includes not only the initial cost of the product, but operating expenses as well. Support services such as medical evaluations, fitting, training and post-sale support are also expensive and not generally available or affordable. The “total cost of ownership” (TCO) includes maintenance, which may be 15 percent of the purchase price per year of ownership, including repairs and training. Overtime TCO runs several times its initial purchase price. For devices that are highly specialized or unusual, costs may be even higher.

Factors That Contribute to High AT Costs

• Small Market Size: Most AT products sell too few units each year to allow for the economies of scale needed for manufacturing competitively priced products. The AT industry is forced to follow a “NASA” model in which a relatively low volume of products are manufactured each year and result in a high per unit price.
   
• Market Fragmentation: It is difficult for AT manufacturers to find and market to all prospective customers because they are geographically dispersed, and in many cases, require different market strategies for different segments of the disabled population. This means that the cost of reaching each potential consumer is higher than for mainstream products.
   
• Product Development and Update Costs: These initial costs can be high and must be amortized across few units. Often, inventors and manufacturers are short of capital for innovation. Additional costs are incurred, as AT manufacturers must frequently update their products to remain compatible with the latest versions of mainstream products.
   
• Lack of Standard Interfaces, e.g., absence-to-date is a standard application programming interface for AT and mainstream computer applications.

Overarching Effort

PROBLEM: One of the most significant barriers to the use and affordability of AT results from fragmentation of public agency service for people with disabilities. Consumers must navigate through a morass of different eligibility or entitlement policies, practices and procedures of state programs that provide AT. The end results are a frustrated agency staff and consumers who cannot get the AT and information and communication technology needed across all ages, environments and life tasks — in communities, schools, work and transportation.

For many consumers, AT is a life span need that affects every area of their lives, everyday. The need for it does not just happen at school or at work; it cuts across every major life activity and often requires a range of solutions that may change with the progression of life and the disabling condition.

Today, people with disabilities face many barriers when they attempt to secure AT devices and services from public agencies:

• Public agencies and schools provide AT that directly relates to agency mandates, not the primary needs of the consumer;
   
• AT does not follow the consumer from one agency to the next;
   and,
  
• AT often cannot be taken from one environment to the next (school use/ home use).

There are major gaps among agencies providing AT, creating what some people refer to as “black holes” in services. For example, students with disabilities who are graduating or dropping out of secondary school are later dropped from VR services with no clear employment path and have no way to obtain the AT they need across all life settings. This applies in particular to information technologies such as adapted computers and certain communication technologies.

C-1. RECOMMENDATION:

Provisions of the AT Act should be substantially strengthened with formula-based, multi-year state grants, improved coordination with the private sector and consumer oversight and consideration for the removal of sunset provisions. Interagency coordination with consumer influence is needed to create an overarching effort that will examine how programs work together, eliminate conflicting, redundant rules and processes, and make it possible for consumers to enter a seamless system at various points for varied reasons. AT Act grants should include core services in multi-year state plans such as:

• AT device demonstrations;
   
• AT equipment loans;
   
• Toll-free telephone and Web site to provide AT information and referral;
   
• AT awareness to public and private sectors; and,
   
• Collaboration with all interested stakeholders.

Boost Consumer Autonomy

PROBLEM: Although the right of choice is an American value, too often customers who need an AT product do not have a “choice” in its purchase. There is a need to reorganize and expand the existing purchasing systems to restore consumer autonomy for the purchase of AT and AMT. The right of choice in making decisions about AT devices and services is crucial to promote self-reliance and ownership, rather than dependency.

C-2. RECOMMENDATION:

Similar to the Social Security Ticket to Work Program, efforts should be made to boost consumer autonomy and the right of choice through an AT ticket initiative. As it now stands, consumers usually do not have the ability to choose the product they need. In addition, because the consumer is not involved in the decision-making process, they do not have a sense of ownership of the technology. Individuals could use tickets to purchase AT devices and services that are currently supported. Advantages to using tickets include:

• Restore Ownership. Tickets for AT and AMT would restore ownership of the technology to the consumer. With ownership comes accountability for making effective decisions and in caring, maintaining and replacing technology.
   
• Better Decisions. Accountability for decisions suggests the need to consider various alternatives carefully to increase the likelihood of better decisions. Self-determination does acknowledge the rights of consumers to make mistakes in their decisions; however, consumer choice does not mean unfettered choice, and all public programs are expected to be good guardians of public tax dollars. The availability of technical support, training and try-out programs will reduce the potential for poor consumer decisions that could lead to abandoning technology when using a ticket.
   
• Increased Market. The use of tickets for AT allows for natural market demand, without interfering with normal business practices or marketing. The end result is to increase the market for AT.

Improving State Equipment Distribution and Loan Initiatives that are Coordinated with State AT Act Programs

PROBLEM: In most states, mechanisms are in place to distribute or loan free or low-cost AT. However, a narrow range of devices are offered due to limited funds and often available only to some people with disabilities. These programs include the Telecommunication Equipment Distribution Program as well as others operated by state AT Act Projects and non-profit organizations. Meanwhile, the range and number of AT devices require more consumer participation and ownership in decisions than ever before. The potential for error is higher, because the variety and complexity of technologies from which to choose is much greater. Individuals with disabilities need more opportunities to “test drive” such devices through state equipment/loan programs.

C-2.1. SUBRECOMMENDATION:

State AT Act programs could pilot the use of a “ticket” on a sliding scale so that consumers could purchase AT and possibly AMT. The provision of such tickets should ensure that consumers have the opportunity to secure credentials expertise in determining the appropriateness of the device along with opportunities for trial use. Pilot programs should possess the following attributes:

• Address a broad range of technologies;
   
• Include assessment services or links to professionals who can provide assessments and assist in making responsible decisions;
   
• Develop program eligibility procedures that are easy to follow for both consumers and administration;
   
• Enable the “try-out” of AT;
   
• Foster free or low-cost lending services when there are no clear funding options;
   
• Include training services;
   
• Facilitate opportunities to meet with peer users of AT/AMT to understand the full potential of AT that may initially seem overwhelmingly complex;
   
• Include consumer participation in developing, implementing and evaluating the program;
   
• Ensure sufficient levels of funding each year;
   
• Include a reliable process for reclaiming and recycling inventory; and,
   
• Have a strong outreach program to market the services.

Missouri Model TAP Programs

Missouri is pioneering a promising approach to a distribution program. Created by a state law, the Telecommunications Access Program (TAP) for Internet supplements the more traditional Telecommunications Access Program (TAP) for Telephone. (For more information, see Appendix C.)

Strengthening “Try-Out” Programs To Increase The Likelihood of Appropriate Choices

PROBLEM: Consumers of mainstream technology have readily available, informal opportunities to examine and compare devices and systems, whereas, individuals deciding which AT device to buy, have less opportunity to examine and compare models and products.

AT devices and software programs that help people use PCs, surf the Internet, work, pursue an education and obtain information should be available for potential purchasers to “try-out.” There are excellent programs within many states that provide people with disabilities opportunities to try out many types of AT and IT. These public and private centers are operated by Centers for Independent Living, AT Act Projects, schools, some libraries, universities and vendor groups. In addition, many AT resource centers offer people the opportunity to “test drive” AT devices and secure assessment services. These resources typically carry small inventories of equipment for trial use due to limited budgets. However, the staff can usually link to many other sources of information and assessment services to find the best solution. As welcome as these programs are, more needs to be done.

C-2.2. SUBRECOMMENDATION:

Existing public libraries, post-secondary schools and Community Technology Centers throughout the nation should have accessible IT tools for people with a variety of disabilities. The AT in these places should be accessible to the public and ought to be planned and budgeted in up front costs, rather than retrofitted afterwards.

• The AT should be prominently displayed.
   
• Grants should be made available to Community Technology Centers that demonstrate an ability to keep their staff well-trained and house the latest AT options for a variety of disabilities.

Public libraries can make information technology more accessible. They are physically accessible, typically within a short commuting distance of community residents and situated near public transportation.

Some Community Technology Centers offer an additional set of advantages. They are staffed with technologically trained persons. Such places could serve as AT “come and try” centers once they are trained on AT and are ready, willing, and able to provide service to individuals with disabilities.

Encourage Greater Employment of People With Disabilities to Restore Purchasing Power

PROBLEM: Employment is crucial to independence, empowerment and improved quality of life. Employment opportunities for people with disabilities are a cornerstone of the President’s New Freedom Initiative. Technology plays a clear and critical role in accomplishing this goal. Having AT in the workplace allows people with disabilities to work. A Harris Poll shows that today — 13 years after passage of the Americans with Disabilities Act — more than 65 percent of working age adults with disabilities are unemployed. More proactive measures are needed to increase employment of people with disabilities, or else many will continue to live at poverty level — unable to afford many types of AT and IT.

C-2.3. SUBRECOMMENDATION:

The federal government should establish a rebate initiative to fund state government agencies and non-profit organizations for 50 percent of the cost of AT-related, reasonable accommodations. This could serve as an incentive to hire and accommodate employees with disabilities. The rebate initiative provides incentives to state governments and non-profit organizations that are similar to the tax incentives available to private sector employers to hire and accommodate employees with disabilities. This initiative could involve state AT Act projects for technical assistance and “try-outs” of equipment before purchase. This recommendation is designed to stimulate state and non-profit organizational hiring of people with disabilities. Additional employment of people with disabilities within state government and non-profits will result in several additional benefits:

• Strengthen their “buying power” as users of AT;
   
• Strengthen or expand the market demand for AT;
   
• Funnel more dollars into strengthening state public and private AT assessment and training services; and,
   
• Save taxpayer dollars, since employed people with disabilities will become taxpayers rather than tax-users.

Stimulating Cooperative Buying Programs

PROBLEM: The majority of public agencies purchase AT on a case-by-case basis, which reduces the potential for group or bulk discounts. These programs are unable to stretch public dollars because they have no mechanism for pooling resources to take advantage of much larger economies of scale.

Funding of AT on a fragmented basis, is very inefficient, administratively. Without a mechanism in place to increase economies of scale, agencies will continue to make most AT and IT purchases, one at a time.

C-2.4. SUBRECOMMENDATION:

Efforts should be made to stretch public and private dollars by pooling purchases. Public and private agencies purchasing AT should consider and/or strengthen online group purchasing arrangements with negotiated discounts and pooling resources among many agencies. This may be achieved through voluntary participation in state programs, the Federal Computer Electronic Accommodation Program (see Appendix B for further information), or as a program of national significance under a membership organization such as the American Association of Persons with Disabilities, which recently announced the availability of its Digital Virtual Credit Union. The pairing of national financial services available to all Americans with disabilities along with the potential for pooling purchases would lower the retail costs of AT and increase the buying power for many more consumers. The availability of this service could be folded into a program of national significance.

• These cost-efficiencies cannot be done in a manner that increases delays for consumers in getting the AT;
   
• These cost-efficiencies cannot be done in a manner that fails to respond to needs for unique and customized products; and,
   
• Government agencies as major purchasers of AT have the largest pool of consumer opinions about AT products. A mechanism for potentially conducting consumer opinion surveys to gather recommendations about certain classes of products may be an area of public/private collaboration to consider.

Tax Programs

PROBLEM: Inclusion of people with disabilities into the mainstream of society through full access to employment, education, health care and independent living represents a key goal of public policy and constitutes an enormous benefit to the American economy. Intelligently crafted and carefully targeted tax law changes could contribute significantly to the affordability of AT by increasing dollars available for AT purchases and incorporating strategies to reduce the retail cost of AT.

C-3. RECOMMENDATION:

Serious consideration should be given to the role tax policy could play in encouraging universal design and assistive technology. For example, tax policy could encourage business to develop and incorporate universal design features into commercial products and services, increase R&D funds dedicated to AMT and AT, and reduce the cost of AMT and AT purchases by individual end-users and the families that support these individuals. AT and UD each have separate challenges.

The following discussion about tax credits and benefits of new and emerging technologies are ideas that merit discussion.

UD Tax Credit

PROBLEM: Under current law, designers, developers and producers of UD and AT, who are mainstream, receive no particular benefits and no specific incentives for this work. Private entities attempting to incorporate UD principles, accessible interfaces or other specialized AT features into their products and designs receive no incentive for doing so through the tax system.

C-3.1. SUBRECOMMENDATION:

Explore ways within the tax system to encourage mainstream manufacturers to practice UD and make their products more accessible.

Technology Business Tax Credit

PROBLEM: Under current law, there is no provision for the business community that designs technology specifically for people with disabilities to do the research and development that is necessary to innovate new products and to upgrade existing technologies.

C-3.2. SUBRECOMMENDATION:

A mechanism could be explored within the tax system to help people who design technology specifically for people with disabilities to facilitate their capability to develop new, more effective technologies, and upgrade existing technologies.

Accessibility to Emerging Technologies

PROBLEM: Emerging technology that enhances communication holds tremendous promise for all Americans. These same technologies are particularly promising for Americans with disabilities. However, accessibility laws are often tied to particular technologies. As technologies change, the benefits of these laws can be left behind. Currently, the accelerating rate of technological change outpaces the statutory and regulatory protections accorded to Americans with disabilities. Emerging technologies not covered by a new law or Amendment to the Telecommunications Act of 1996 include interactive and enhanced television and broadband. Many technologies on the horizon — any one could emerge as the “next promising invention” — must be anticipated along with its impact on people with disabilities.

C-4. RECOMMENDATION:

Help to ensure the accessible design of all information and communication products and services.

New and Emerging Technologies

PROBLEMS: Current laws require accessibility in telecommunications products and services and in broadcast, cable-cast and satellite television programming. This means that TV programs need to be captioned if they are broadcast or cable-cast. But what happens if the programs are transmitted over the Internet? Are they still considered as airing on “television” in the sense of the 1990 law? And, what if television combines several different kinds of media so that it is made interactive and enhanced — must that be accessible by law? Should programming on the Web by a broadcaster be accessible? Similarly, Section 255 covers “telecommunications products” and “telecommunications services”— called “narrowband” products and services. What about broadband? Currently, only voice-grade and traditional communications are covered; it is not clear whether Section 255 extends to broadband-compatible and required technologies. In fact much of this territory remains unclear and the FCC has not used all of its authority with respect to requiring these public interest obligations. Assurances are necessary to provide accessibility in new and emerging technologies.

EMERGING TECHNOLOGIES AND THEIR BENEFITS

Interactive and Enhanced Television

Interactive and enhanced television incorporates elements of broadcast/cable-cast television with aspects of telecommunications. Since virtually every American home has at least one TV set, there is the potential for a very high penetration rate. This means that widely anticipated interactive services provided through a “magic box” could bring the Information Age to most Americans with disabilities at a reasonable cost. Yet, this will occur only if the interactive services are accessible to and usable by people with disabilities.

Broadband

Broadband is an emerging technology that holds great potential for improving the lives of Americans with disabilities. Traditional telephony is “narrowband” meaning that it is designed to carry analog (voice) communications. It can also carry text such as e-mails and faxes and with difficulty a small amount of video. In contrast, broadband is designed to carry digital signals and is expressly fitted to carry voice, data and video, concurrently.

Next Generation Internet

The next-generation Internet could include services for people with disabilities such as auditory descriptions of visual images for people who are blind or have low vision. Real-time speech-to-text translation services enable people who are deaf or hard of hearing to participate in meetings or presentations. High-speed digital communications also facilitate sign-to-sign communication between remotely located individuals who are deaf.

C-4.1. SUBRECOMMENDATION:

Develop and administer courses designed to help industry build mainstream business cases around assistive design.

These methodologies focused on maximizing the accessibility and usability of Electronic and Information Technology (E&IT) are required to accommodate the following mainstream consumer groups. Similarities between these consumer groups (see chart, column 1) and consumers with disabilities (see chart, column 3) are listed below. Demographic data, of the categories below, can be found at http://www.ideal-group.org/ideas_2003/ideas_2003_final.ppt. (You will need to be online to view this PowerPoint presentation [2.0 MB]. You will need to use PowerPoint 97 or greater to access the links contained in the presentation. Please be patient, this may take several minutes to download to your computer.)

Accessibility in All Products

PROBLEM: Information and communication technology that emerges is not always reviewed from the earliest stages with regard to what the impact will be on people with disabilities. Within the industry and its regulatory bodies there is a lack of empowerment to report on a “horizon scan” of accessibility issues. “Keeping up” is not enough. We must anticipate changes in the industry so that appropriate regulations can arrive simultaneously with the product. Research should consider and report what the upcoming barriers are so that potential solutions can be proposed in advance.

C-4.2. SUBRECOMMENDATION:

Encourage requiring accessibility in information and communication products and services sold in the United States. Accessibility of mainstream products should be considered before compatibility with AT; the business practices used to design, market and support products and services must be accessible as well. However, unlike the current Section 255 of the Telecommunications Act, broadband communications and other advanced technologies should also be covered.