Skip to Content

AFBAmerican Foundation®
for the Blind

Expanding possibilities for people with vision loss

AFB Blog

Track This Blog By E-mail

The American Foundation for the Blind and Coalition of Aging Organizations Oppose American Health Care Act Provisions

The American Foundation for the Blind is proud to be a member of Leadership Council of Aging Organizations (LCAO), the country’s preeminent coalition representing older Americans.

This week we joined the LCAO in expressing our strong opposition to provisions of the House-passed American Health Care Act (AHCA) because of the harm they would inflict on our nation’s seniors. The following are key points taken from a letter to Senate Majority Leader McConnell and Minority Leader Schumer.

We are deeply concerned that the AHCA would:

  • Increase the number of uninsured Americans by 23 million
  • Significantly increase health care costs for millions more—particularly older adults
  • Cut Medicaid by $834 billion
  • Impose strict per capita caps on federal contributions to Medicaid, which have nothing to do with repealing the Affordable Care Act (ACA)
  • Jeopardize critical home and community-based services (HCBS), nursing home care, and other services for family members with disabilities
  • Dramatically increase health care costs and make coverage less available for older adults aged 50-64 who are not yet eligible for Medicare
  • Weaken current consumer protections that limit consumers’ out-of-pocket spending and prohibit insurance companies from capping benefits on an annual and lifetime basis, even for people covered by large employers

Medicaid Proposals Harm Older Americans, Especially Those Needing Long-Term Care

Medicaid is a lifeline for 7 million low-income seniors. Medicaid covers 2 in 3 nursing home residents. With nursing home care often costing about $100,000 a year, seniors quickly run through their life savings before turning to Medicaid.

Home and community-based services (HCBS), which are not covered by Medicare, enable older Americans and people with disabilities to stay in their own homes and with their families. They are cost-effective, and they help struggling family caregivers keep loved ones together.

But HCBS are at greatest risk of major cuts because they are optional under Medicaid, while nursing home care is mandatory. On average, Medicaid dollars support nearly 3 older people and adults with disabilities with HCBS for every 1 person in a nursing home.

The AHCA also repeals Community First Choice (CFC) funding, which would further reduce access to cost-effective HCBS.

The Administration also recently proposed dialing down growth rates to cut Medicaid by an additional $610 billion. The total combined Medicaid cut would be about $1.3 trillion over 10 years—a massive, unprecedented 45% cut in 2026.

Under per capita caps, the federal government provides states with a fixed, limited payment based on a preset formula that would inevitably fail to reflect fluctuating service needs among states and their residents during periods of economic growth and recession, as well as real growth in long-term care costs. State variations in spending would be permanently frozen in place based on 2016 costs, creating problems for all states and especially those that faced budget constraints or reduced spending in that year.

The effect will be a huge increase in costs being passed on to states. Some states will use state tax dollars to make up for the loss in federal funds—meaning that they’re either raising taxes (unlikely) or taking money from other important state programs. Other states will not have enough resources to make up for the loss of funds and thus will reduce services.

Other important Medicaid per capita cap concerns include:

  • The caps fail to account for the growing aging population and the fact that seniors aged 85+ have 2 1/2 times higher Medicaid costs than people aged 65-74. The 85+ population is the nation’s fastest growing age group and is projected to triple by 2050.
  • Proposed Medicaid cuts will result in significant job losses and reduced wages for health and long-term care workers and lower economic growth. Many of the estimated 4.4 million nursing facility and home care workers Medicaid pays for would lose their jobs or have their salaries cut, further worsening current direct care worker shortages.
  • Medicaid spending is not out of control. Medicaid costs per beneficiary are much lower than for private insurance and have been growing more slowly than under private employer coverage.

The Age Tax Dramatically Increases Costs for Older Adults

The AHCA also would dramatically increase costs and make coverage less available for older adults aged 50-64 who are not yet eligible for Medicare by imposing an Age Tax that would allow insurance companies to charge older adults five times or more what younger adults pay for health insurance premiums in the individual market. The bill would significantly reduce tax credits that help lower and modest income older adults pay for coverage.

In addition, the AHCA provides for state waivers that would allow insurance companies to charge people with pre-existing conditions significantly higher rates based on their health. This will result in a less healthy population going into Medicare and higher program costs.

Taken together, the bill’s changes to age rating and tax credits will dramatically increase the financial burden of older Americans and make coverage significantly less affordable, especially for those with modest incomes, and likely will cause many to go without coverage and necessary care.

According to the recent CBO cost estimate, the AHCA would increase premiums by a shocking $14,400 per year—from $1,700 to $16,100 for a 64-year-old with income below $26,500 per year.

The AHCA also would harm older Americans with chronic conditions because it would allow states to let insurance companies significantly increase premiums for those with pre-existing conditions. Nearly half of Americans aged 50-64 have a pre-existing condition for which they could have been denied coverage prior to the ACA.

In summary, we join the coalition in strongly urging the U.S. Senate to oppose all of these harmful proposals, which would dramatically impact the health and long-term care of millions of older Americans and their families.

Read the full text of the joint letter to Majority Leader McConnell and Minority Leader Schumer.

Related Links

In the News
Public Policy

Creating a World of No Limits

Kirk Adams at the 2017 Helen Keller Achievements Awards with No Limits visible on the screen behind him, in print and simulated braille

Last night's Helen Keller Achievement Awards were a huge success, and we couldn't have done it without your help. We are so grateful to all of our partners, friends, and donors.

This was our 21st year handing out these awards, and looking back, I can only feel gratified and inspired by the sheer scope and caliber of the Helen Keller Achievement Award recipients.

From Stevie Wonder to Steve Jobs, AFB has recognized profound contributions by artists and inventors, corporate leaders and entrepreneurs—trailblazers across all fields. Some defied society’s perceived limits of disability to achieve greatness; others created tools that put greatness within reach for greater numbers of people with disabilities.

Over the next few months, you're going to see AFB evolve, as creating a world with no limits becomes our sole mission. We will relentlessly pursue answers to the problems that need to be solved. We will tirelessly address the needs of people who are blind, and we will enthusiastically mobilize leaders to create the change that makes a world with no limits possible.

We’re at a critical crossroads, and there is an opportunity, if we are ready to seize it together. At this very moment, technology is advancing at lightning speed. Government policies in education and access are being reformed. Through research and data, we have unprecedented ways of looking at old problems and finding new solutions. This is the moment. But if we don’t seize it now—if we choose the status quo instead—we will be leaving behind individuals who are blind or visually impaired in a world of unacceptable outcomes—where they face higher rates of unemployment, poverty, and illness than those who are sighted, despite having just as much talent and ambition.

AFB can’t do this alone. Creating a world with No Limits will require the partnership of teachers, administrators, policymakers, corporations, technology firms, and others.

We at AFB take inspiration from the words of Helen Keller, who was the first person to teach us that a life with No Limits is not only possible—it’s a human right for all. These words are just as true today as they were when she said them in 1903: "Optimism is the faith that leads to achievement; nothing can be done without hope."

At AFB, we are hopeful. We have every reason for optimism. The future is ripe with potential—especially when we all work together—to fulfill our mission to create a world with No Limits.

From left to right, Larry Kimbler, Kirk Adams, Brian Macken (Netflix), Patricia Walsh (emcee), Shawn Lauriat (Google), and Chris Downey, AIA (architect).

Please continue to support AFB in our essential work. And check out what we’re doing! Sign up for our newsletters and email alerts, and follow us on Twitter and Facebook. There’s a lot happening, and we’d like you to be part of it.

No Limits: Accessible Technology from Helen Keller to Google

This Thursday evening, the American Foundation for the Blind will be honoring Google for pouring its considerable talent and resources into developing technologies that improve how people with vision loss live, work, and play. This past year saw significant accessibility improvements in a range of Google's products, including the Android mobile operating system and TalkBack screen reader, the Chrome Web browser and operating system, the ChromeVox screen reader and the G Suite apps on the Web, iOS, and Android platforms.

AFB is thrilled that Google is working so diligently in a field that AFB has long championed. From its earliest days, AFB saw the potential for technology to create a world with no limits for people who are blind or visually impaired. AFB helped pioneer the audio book and our champion, Helen Keller, was herself an avid adopter of new technologies. She helped promote the distribution of radios in 1928 and frequently tested new equipment such as the electric braillewriter (pictured in the photograph above).

Last winter, AFB collaborated with Google on a hugely successful multi-day seminar exploring the accessibility features of Google's business and classroom tools. The training was led by Google engineers and facilitated by AFB staff. Participants received hands-on experience using the inclusive features and functionalities built into Chromebooks, Android devices, and Google apps—such as Google Docs, Calendar, Gmail, Google Drive, and Google Play.

Trainers left the seminar excited about the possibilities these technologies offer their clients for work, education, and recreation. As one attendee said, "It was great to meet such an amazing group of AT specialists from all over the country! This was a wonderful training and I am so grateful for the generosity and hospitality of AFB and Google."

Helen Keller would be overjoyed to see the products that are now available to people with sensory disabilities, and we know she would be using all of them. She had an unshakable belief in the power of human innovation and would be the first to honor Google for its enormous achievements.

Helen Selsdon showing Helen Keller artifacts to Google employees

Google employees visiting the Helen Keller Archive

Congratulations to Google and to the other Helen Keller Achievement Award recipients, Netflix and architect Chris Downey—all of whom are working to create a more accessible, usable, and inclusive world. We look forward to honoring them all at the 21st Annual Helen Keller Achievement Awards!

Assistive Technology
Helen Keller
Helpful Products

From Helen Keller to Netflix: Making Popular Culture Accessible

Helen Keller in her vaudeville dressing room. She is seen sitting with her head tilted slightly back as she faces slightly towards the camera. She is applying powder with her right hand, while in her left she holds a cosmetic item. Her left hand is leaning on a table in front of her that is covered with other make-up items. She wears an ankle length, sleeveless shimmering dress that is loose except at the waist. A fur coat and silk or satin items of clothing are visible behind her.

Helen in her dressing room in a vaudeville theatre, circa 1920

On June 15, the American Foundation for the Blind will be honoring Netflix with a Helen Keller Achievement Award for its work to broaden access to television shows, documentaries, and feature films on its streaming service.

Netflix has added over 3,500 hours of described content (learn more about video description) since launching its first audio described title over two years ago—Marvel’s Daredevil, a show about a blind superhero—and is committed to increasing the number of audio-visual translations for TV shows and movies to ensure all Netflix members are able to enjoy the stories they love.

Helen Keller was an avid participant in and contributor to popular culture. In the 1920s, she and her teacher, Anne Sullivan, spoke on the vaudeville circuit. They went on tour, giving lectures and performing in shows that featured drama, comedy, and music. Helen enjoyed the glamorous lifestyle, unlike Anne, who found it tiring.

In 1918, Helen and Anne traveled to Hollywood to make the movie "Deliverance," a silent movie about Helen's life. In the film, Helen and Anne starred as themselves. While on the west coast, Helen had the opportunity to meet many famous movie stars, such as Charlie Chaplin.

Viewed outdoors, Charlie Chaplin stands behind Polly Thomson, Helen Keller and Anne Sullivan Macy who are all seated on wicker chairs. Their faces are seen in profile as they look towards the right of the image, in the direction that Chaplin is pointing. The women's skirts and dresses are long. Thomson and Macy wear hats. Macy is manually signing into Keller's right hand.

Charlie Chaplin stands behind Polly Thomson, Helen Keller, and Anne Sullivan Macy who are all seated on wicker chairs, 1918.

You may wonder how Helen was able to appreciate Chaplin's movies. A newspaper article from 1921 describes Helen enjoying a special showing of one of his hit movies via on-the-fly, hand-spelled descriptions provided by her teacher, Annie.

On one side of Miss Keller sat her tutor Mrs. Annie Sullivan Macy. On the other sat her mother, Mrs. Arthur Keller. As the film unrolled smoothly in the action of “The Kid,” Mrs. Macy touched with her finger-tips Miss Keller's hand. The swift tatto [sic] of fingers kept pace with the action of the play. And Miss Keller laughed delightedly at the comedy that unrolled before her.

"Wonderful,” she said.

These days, viewers who are blind or visually impaired don't have to rely on a sighted friend or family member's descriptions to enjoy popular culture. The adoption of audio description for many of Netflix’s most popular titles has created a more inclusive environment and opened up entertainment choices for viewers with vision loss. In addition, Netflix has made its website and mobile apps accessible to those who use VoiceOver and screen-reading software.

We look forward to celebrating Netflix's achievements in making popular culture accessible to people with disabilities next week, at the 21st annual Helen Keller Achievement Awards!

Helen Keller
Social Life and Recreation
Video Description

Analyzing Labor Markets and Employment Outcomes for the American Foundation for the Blind

Lorenzo Amani


Hello, AFB community, I'm Lorenzo Amani, currently a second-year doctoral student at Virginia Tech in the College of Public Administration and Public Affairs. I'm also a graduate assistant for Virginia Tech's Office of Budgeting and Financial Planning. My research interests are in labor market policy analysis, human capital management, and workforce development. I'm assisting the AFB staff this summer to develop various research designs that could inform employment and workforce development practitioners who serve people who are blind or visually impaired. Thus far, I've learned of the many challenges of this endeavor. Most challenging is the lack of specific employment data and the varying metrics or lack thereof for measuring employment outcomes.

The AFB Experience

Working at AFB has been an astonishing learning experience for me. I was exposed to blind baseball, blindness simulations, accessibility demonstrations, and I typed my name in braille using a Perkins braille writer! Paul Schroeder demonstrated how Google Glass technology is being used to increase mobility for people with vision loss. Mark Richert (AFB's Director of Public Policy) impressed me with his positive outlook, and how seamlessly he navigated the office space and public transportation in the city. After speaking with Lou Tutt (Executive Director of the Association for Education and Rehabilitation of the Blind and Visually Impaired) and Rebecca Sheffield (AFB's Senior Policy Researcher) about their journeys in the field. I'm convinced that practitioners in this field are unique in their passion and spirit towards serving others. The conversations and direct observations that I've had with the AFB team and the blindness community have deconstructed my subconscious assumptions about the capabilities of people with vision loss. I'm very much appreciative of such a pleasant and enriching experience.

Call for Research from the Labor Market Perspective

As a scholar of labor market policy, I believe that observing employment conditions (through a descriptive labor market outcomes framework) is relevant to AFB's mission and could aid in the development of solutions to address the overall employment rate for citizens who experience blindness or vision loss. Thinking about the relationships within two microeconomic frames, each comprised of two areas, has helped me theorize applicable research questions and hypotheses. The two frames of labor-market behaviors and outcomes are labor supply and demand.

Under the labor supply frame, the two areas are households and educational institutions, which are the entities that discover, cultivate, and produce aptitudes and skills that are sold as labor supply in the labor market (Jacobsen & Skillman, 2004; Rima, 1996).

For the labor demand frame, the two areas are government and firms. Firms are the source of demand for labor in the labor market, and government is the rule-making entity that intervenes as necessary to influence the demand and supply sides of the labor market in pursuit of a stable and/or healthy economy (Jacobsen & Skillman, 2004; Rima, 1996).

I propose that these frames and areas will help to shape an important approach to employment research in the field of blindness and visual impairment.

In a short time, I've gained a considerable amount of knowledge of the challenges and opportunities that are inseparable from goals of helping citizens with blindness or vision loss live fulfilled lives. Studies have shown that meaningful employment leads to a greater sense of independence and purpose, and there are many organizations such as the Association for Education and Rehabilitation of the Blind and Visually Impaired and the National Industries for the Blind, who work tirelessly on supporting gainful employment. In consideration of my statement on the importance and relevance of labor market perspectives, I ultimately want to discover ways to increase the skill and talent levels of citizens with vision loss through households and educational institutions and decrease the barriers of employment by 1) using government policies and 2) addressing firms' behavior to influence their hiring practices. To put it simply: increase talent and decrease barriers.

Research is essentially a methodical form of storytelling. If we can better tell the employment story of citizens in the blindness community, then households and educational institutions will be able to better prepare citizens with vision loss for gainful employment. Simultaneously, policy makers and hiring managers will be better informed on how reduce structural and subjective employment barriers.

At face value, this benevolent endeavor could appear oblivious to the substantial challenges surrounding the employment issue. Nonetheless, I firmly believe that employment research can produce real outcomes, by asking the right employment questions and building an evolving database centered around labor market statistics for people with vision loss.

Undoubtedly, there are many ways to approach this type of research. Yet, in consideration of feasibility, accuracy, and AFB's vision, first we plan to observe the employment outcomes that can be attributed to the implementation of the Workforce Innovation and Opportunity Act (WIOA) by vocational rehabilitation state agencies. I'll look at how state vocational rehabilitation agencies measure their employment outcomes to identify areas for improvement, while using labor market and workforce development theories to make a normative push for how state vocational rehabilitation agencies should measure their employment outcomes.

At a minimum, the data gathered will add to the literature in the field. Most importantly, it can help AFB and other related organizations influence policy with verifiable employment data.

Final Thoughts

In conclusion, I stumbled upon a quote from Helen Keller this week.

Helen Keller, smiling, at about age 80, with the quote: I hope one day to see enough braille presses, libraries, schools, and training centers and teachers to assure all persons the opportunities they would have had, had they not been blind. This is my greatest purpose in life. This card was used as a Christmas appeal from Helen Keller on behalf of the AFOB and the Helen Keller World Crusade for the Blind in 1964.

When I encountered this quote, I felt the spirit of her, every person, organization, and entity who works tirelessly to support people with disabilities, especially those with limited or no vision. Helen stated, "I hope one day to see enough braille presses, libraries, schools, training centers, and teachers to assure all persons the opportunities they would have had, had they not been blind. This is my greatest purpose in life." (AFB Press, 2000).

Through my research perspective, I interpreted her use of the word "opportunities" to signify "employment opportunities," which are key to engendering purpose, independence, liberty, and ultimately life fulfillment. Through a collaborative, scrupulous, and focused research agenda, AFB can continue to have considerable influence in advancing equality and opportunity in the lives of people with vision loss.


Keller, Helen (2000). To Love This Life: Quotations by Helen Keller. New York, NY: AFB Press.

Jacobsen, J. P., & Skillman, G. L. (2004). Labor markets and employment relationships: A comprehensive approach. Malden, MA: Blackwell Pub.

Rima, I. H. (1996). Labor markets in a global economy: Macroeconomic perspective. Armonk, NY: Sharpe.

Personal Reflections
Public Policy