    [Senate Hearing 117-320]
    [From the U.S. Government Publishing Office]

                                                           S. Hrg. 117-320

                         CLICK HERE: ACCESSIBLE FEDERAL
                             TECHNOLOGY FOR PEOPLE
                            WITH DISABILITIES, OLDER
                            AMERICANS, AND VETERANS

    =======================================================================

                                    HEARING

                                   BEFORE THE

                           SPECIAL COMMITTEE ON AGING

                              UNITED STATES SENATE

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 WASHINGTON, DC

                                   __________

                                 JULY 28, 2022

                                   __________

                               Serial No. 117-20

             Printed for the use of the Special Committee on Aging

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                  __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    48-178 PDF*(Star Print)      WASHINGTON : 2022

    -----------------------------------------------------------------------------------

                           SPECIAL COMMITTEE ON AGING

                  ROBERT P. CASEY, JR., Pennsylvania, Chairman

    KIRSTEN E. GILLIBRAND, New York      TIM SCOTT, South Carolina
    RICHARD BLUMENTHAL, Connecticut      SUSAN M. COLLINS, Maine
    ELIZABETH WARREN, Massachusetts      RICHARD BURR, North Carolina
    JACKY ROSEN, Nevada                  MARCO RUBIO, Florida
    MARK KELLY, Arizona                  MIKE BRAUN, Indiana
    RAPHAEL WARNOCK, Georgia             RICK SCOTT, Florida
                                         MIKE LEE, Utah
                                  ----------
                     Stacy Sanders, Majority Staff Director
                     Neri Martinez, Minority Staff Director

                             C  O  N  T  E  N  T  S

                                  ----------

                                                                       Page

    Opening Statement of Senator Robert P. Casey, Jr., Chairman......     1
    Opening Statement of Senator Tim Scott, Ranking Member...........     3

                               PANEL OF WITNESSES

    Eve Hill, Attorney and Partner, Brown, Goldstein & Levy, LLP,
      Washington, D.C................................................     5
    Anil Lewis, Executive Director for Blindness Initiatives,
      National Federation of the Blind, Atlanta, Georgia.............     7
    Jule Ann Lieberman, (accompanied by her husband John Lieberman)
      Assistive Technology Program Coordinator, TechOWL, Devon,
      Pennsylvania...................................................     9
    Ronald Holmquest, Retired and U.S. Navy Veteran, Mount Pleasant,
      South Carolina.................................................    11

                               CLOSING STATEMENT

    Closing Statement of Senator Tim Scott, Ranking Member...........    27

                                    APPENDIX
                          Prepared Witness Statements

    Eve Hill, Attorney and Partner, Brown, Goldstein & Levy, LLP,
      Washington, D.C................................................    33
    Anil Lewis, Executive Director for Blindness Initiatives,
      National Federation of the Blind, Atlanta, Georgia.............    44
    Jule Ann Lieberman, Assistive Technology Program Coordinator,
      TechOWL, Devon, Pennsylvania...................................    49
    Ronald Holmquest, Retired and U.S. Navy Veteran, Mount Pleasant,
      South Carolina.................................................    51

                            Questions for the Record

    Eve Hill, Attorney and Partner, Brown, Goldstein & Levy, LLP,
      Washington, D.C................................................    55
    Anil Lewis, Executive Director for Blindness Initiatives,
      National Federation of the Blind, Atlanta, Georgia.............    59
    Jule Ann Lieberman, Assistive Technology Program Coordinator,
      TechOWL, Devon, Pennsylvania...................................    63
    Ronald Holmquest, Retired and U.S. Navy Veteran, Mount Pleasant,
      South Carolina.................................................    66

                           Statements for the Record

    American Council of the Blind, written statement.................    71
    American Foundation for the Blind, written statement.............    74
    Blinded Veteran's Association, presented by James R. Vale, Esq.,
      written statement..............................................    82
    Consortium for Constituents with Disabilities, written statement.    87
    Deepa Goraya, Attorney, written statement........................    93
    Jonathan Lazar, Ph.D., LL.M., Professor, written statement.......    95
    Ken Lebron, Director, Berks County Veterans' Affairs, written
      statement......................................................   102
    National Association of the Deaf, written statement..............   106
    National Disability Rights Network, written statement............   108
    Ronald Biglin, written statement.................................   112

                         CLICK HERE: ACCESSIBLE FEDERAL
                             TECHNOLOGY FOR PEOPLE
                            WITH DISABILITIES, OLDER
                            AMERICANS, AND VETERANS

                                  ----------

                            THURSDAY, JULY 28, 2022

                                           U.S. Senate,
                                    Special Committee on Aging,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 10 a.m.,
    virtually via Webex, Room 562, Dirksen Senate Office Building,
    Hon. Robert P. Casey, Jr., Chairman of the Committee,
    presiding.
        Present: Senators Casey, Blumenthal, Rosen, Tim Scott,
    Braun, and Rick Scott.

                      OPENING STATEMENT OF SENATOR
                     ROBERT P. CASEY, JR., CHAIRMAN

        The Chairman. The hearing will come to order. Thank you
    everyone for being here this morning. I will start with my
    opening, then I will turn to Ranking Member Scott.
        This week marks the 32nd anniversary of the signing of the
    Americans with Disabilities Act. As we commemorate that
    anniversary, our Committee will examine an important disability
    issue, how to improve the accessibility of Federal information
    technology for people with disabilities.
        The COVID-19 pandemic accelerated a long-term shift in
    delivering government services using virtual front doors
    instead of physical front doors. Unfortunately, over the years,
    the U.S. Government has not prioritized making these virtual
    front doors accessible to people with disabilities, especially
    most recently. Digital access significantly affects older
    Americans and veterans, who experience disabilities at higher
    rates than the general population and more frequently use these
    government services.
        Federal law requires that the Executive branch agencies
    make their technology accessible to people with disabilities.
    However, bipartisan oversight that I have led shows the U.S.
    Government is falling short on digital accessibility. I want to
    thank Ranking Member Scott and our Aging Committee colleague
    Senator Burr for joining me in these oversight efforts.
        In 2018, my office heard from veterans who have a
    disability or more than one disability, who reported problems
    accessing the Department of Veterans Affairs' websites and
    kiosks. In response, I worked alongside Senator Jerry Moran to
    pass the bipartisan VA Website Accountability Act in 2020. That
    law requires the VA to report on the accessibility of its
    websites and intake kiosks.
        The resulting report had stark findings. Fewer than 10
    percent--let me say that again--fewer than 10 percent of its
    websites were fully accessible as of last Fall and the
    Department's plans to fix them were, in a word, inadequate. My
    understanding is that the VA will soon be responding to the
    letter I sent with Senator Scott and other colleagues regarding
    these longstanding accessibility shortfalls. I will be
    reviewing those plans and look forward to working with the
    Department to address these longstanding issues.
        While serious, the VA's accessibility shortfalls are not
    unique, unfortunately. A long list of Federal agencies, and
    even the White House, have settled lawsuits in recent years
    alleging their websites and technology are not accessible. That
    is why I am concerned that the Department of Justice has not
    evaluated Federal technology access for a decade. Federal law
    requires, as I said, these evaluations every two years.
        The Biden Administration has rightfully prioritized
    improving digital access, but years of inattention to
    accessibility means there still is a lot of work to do.
        Someone who just happens to live in the same county I live
    in--his name is Ron Biglin and I am holding up a letter, some
    of which I have highlighted--Ron Biglin, he lives in Clarks
    Summit, Pennsylvania, not too far from Scranton. He is one of
    the people who has suffered from this inattention. He submitted
    a statement for the record, and I will make that statement part
    of the record.
        Ron Biglin is an Air Force veteran, who is blind. He can
    fish, kayak, and even do online banking, but the VA's My
    HealtheVet site does not work with his screen reader, making
    him unable to use it. Ron wrote a pertinent part in his
    statement: ``When you are visually impaired you want to be as
    independent as possible and having problems getting on VA
    websites takes away this independency. If the VA could lead the
    way to make access easier, this would be a great plus and then
    also other government agencies could do the same.'' I could not
    have said it any better than Ron Biglin said it.
        We would not ask someone using a wheelchair to walk up the
    courthouse steps, but in a real sense we are doing something
    similar when we ask people with disabilities to use Federal
    websites. We are saying that all the time in government
    services, and thankfully it has worked for a lot of Americans,
    but when we are telling people to use these Federal websites,
    mobile apps, and other technologies that are inaccessible, that
    makes no sense. We have got to do better than that as a Federal
    Government and as a society.
        I thank our witnesses for being here today and I look
    forward to hearing how to address these issues for people with
    disabilities, for seniors, and for veterans across the country
    like Ron Biglin and so many others.
        I will now turn to Ranking Member Scott.

                     OPENING STATEMENT OF SENATOR
                       TIM SCOTT, RANKING MEMBER

        Senator Tim Scott. Thank you, Mr. Chairman, and thank you
    to the witnesses for being here today. Without any question we
    look forward to hearing your testimony.
        For many of our Nation's seniors and people with
    disabilities, accessing Federal resources and services has been
    too big of a problem that must be solved. This is especially
    true for our veterans, and that is why Senator Casey and I are
    working to solve problems with a variety of solutions. I thank
    you, Mr. Chairman, for your participation in so many of the
    efforts to include working with the VA and to improve the
    website accessibility for disabled veterans and disabled VA
    employees. We also requested the DOJ comply with reporting
    requirements regarding improved website accessibility for
    Americans with disabilities.
        In May, I hosted an event to honor our active duty,
    reserve, and national guard and military personnel, defense
    contractors, and those who fought in Afghanistan and Iraq. We
    had nearly 700 attendees at home in Charleston, South Carolina.
    It was a wonderful event. It was a wonderful way for us to
    acknowledge the incredible sacrifice, and those who serve our
    country should be honored on a consistent basis.
        I would like to acknowledge our South Carolina
    servicemembers, veterans, and those currently stationed at
    military bases throughout this Nation.
        One out of four of our veterans have a disability that is
    consistent with their military service, and the median age of
    our veterans is around the age of 65.
        Tony Green is a veteran from Charleston, South Carolina,
    who served in the Navy for eight years. Following his military
    career, he had problems assimilating into civilian life and
    started suffering severe bouts of depression. He went from
    living in the comfort of his own home to living in a homeless
    shelter. Determined to change his life, he reached out to the
    VA and received treatment for his bipolar disorder.
        The VA and its telehealth services, which he accesses from
    his phone and laptop to receive care and manage his medication,
    have made all the difference in the world for Tony. He took
    advantage of the VA's comprehensive work-therapy program that
    led him to a job with the Palmetto Goodwill's Ability One
    program. He went from a food service worker, to cook, to
    supervisor. Tony is now an assistant project manager in
    downtown Charleston. He is also the first homeowner in his
    family.
        Telehealth became a godsend for millions of Americans like
    Tony, especially our seniors during COVID-19. Patients
    connected with their doctors even when they were isolated. From
    March 2020 through February 2021, more than 28 million Medicare
    beneficiaries used telehealth services.
        Donna Avant, named the 2021 Pharmacist of the Year, has
    been providing telehealth education free of charge, to the
    residents of Bamberg County, South Carolina, since 2020, in
    this rural community, where the nearest doctor is 12 miles
    away, the nearest emergency room is half an hour away, and,
    more that 100 seniors received free tablets for health
    screenings in chronic disease education, such as diabetes and
    hypertension.
        Seniors use Zoom and the phone. It improved access to
    health care, to doctors, and specialists that they otherwise
    might not be able to see. South Carolina is a leader in
    telehealth innovation. The Medical University of South Carolina
    has one of just two federally recognized telehealth centers of
    excellence in the Nation.
        In 2021, I introduced the Telehealth Modernization Act with
    Senator Schatz and a bipartisan group including Senators
    Collins and Warnock, which makes telehealth flexibilities
    permanent even after this pandemic is completely done. Without
    congressional action, however, these emergency provisions will
    end, and they will end soon, like in mid-October of this year.
    For the tens of millions of Medicare beneficiaries and others
    who rely on telehealth services, that would be tragic.
        Federal regulations have not kept up with the technological
    advancements that we have seen in this country. We must keep
    telehealth available and accessible for all Americans,
    including our seniors, our military heroes, and disabled
    individuals, so that they can take care of themselves and meet
    the needs they have.
        I look forward to learning from today's witnesses. Thank
    you, Mr. Chairman, and I yield back.
        The Chairman. Ranking Member Scott, thank you for your
    statement. I will now move to witness introductions.
        Our first witness is Ms. Eve Hill, a disability rights
    lawyer at Brown, Goldstein & Levy. Ms. Hill previously as
    Deputy Assistant Attorney General at the U.S. Justice
    Department in the Civil Rights Division, where she was
    responsible for oversight of the division's disability rights,
    education, and Title VI enforcement and the American Indian
    Working Group.
        She founded Inclusivity Strategic Consulting, a unit of the
    law firm designed to help businesses, organizations, government
    agencies, and industry groups to achieve real inclusion of
    people with disabilities in their workforces and their
    communities.
        Our second witness is Mr. Anil Lewis, Executive Director
    for Blindness Initiatives at the National Federation of the
    Blind. Mr. Lewis oversees the development and implementation of
    projects that improve the education, employment, and quality of
    life of all blind people.
        Our third witness is Ms. Jule Ann Lieberman, the Assistive
    Technology Specialist at TechOWL's Institute on Disabilities at
    Temple University in Philadelphia. Ms. Lieberman conducts
    assistive technology demonstration training for TechOWL and is
    responsible for public awareness activities at that
    organization. She is also blind herself and she will tell us
    how she has been personally affected by accessibility problems
    with Federal websites.
        Ms. Lieberman is accompanied by her husband, John
    Lieberman. She is also accompanied by her guide dog, Bob. That
    is a good name, and for our fourth and final witness I will
    turn to Ranking Member Scott.
        Senator Tim Scott. Thank you, Mr. Chairman.
        Ronald G. Holmquest retired to South Carolina after a
    successful career in the Navy and later as a computer
    programmer and small business owner. Raised in New Jersey, he
    joined the U.S. Navy after graduating from high school. He
    served overseas in Japan and was honorably discharged in 1966,
    having been promoted to petty officer second class.
        He then pursued a career as a computer programmer and IT
    specialist in the New York City area. More importantly, he
    married Bonnie and they started a family. Ronald and Bonnie
    just celebrated their 56th wedding anniversary. What a
    blessing.
        Seeking a different pace, they moved to Vermont, where
    Ronald continued his work as an IT specialist and a small
    business owner. In 2015, he moved to Charleston--good
    decision--area to be closer to his family and granddaughter,
    who is now 10 years old. He is proud to have moved to South
    Carolina.
        Currently Mr. Holmquest receives care for chronic medical
    conditions at the Ralph H. Johnson VA Health System. He relies
    on telehealth and remote home monitoring devices to stay
    connected to his care team.
        Mr. Holmquest, we look forward to your hearing testimony
    today, and once again, happy 56th wedding anniversary.
        The Chairman. I join in those sentiments. Thank you,
    Ranking Member Scott.
        Before we move to witness statements I just want to make it
    clear for our audience that various Senator will be in and out
    of the hearing today. Thursday mornings are busy here. Lots of
    hearings and commitments that people have, so we will be
    acknowledging Senators as they arrive and as they have been
    present. I know we are joined already by Senator Rick Scott,
    and so we will now move to our first witness statement.
        Ms. Hill, you may begin.

    STATEMENT OF EVE HILL, ATTORNEY AND PARTNER, BROWN, GOLDSTEIN &
                      LEVY, LLP, WASHINGTON, D.C.

        Ms. Hill. Good morning, Mr. Chairman. Good morning, Mr.
    Ranking Member and members of the Committee. As has already
    been said, my name is Eve Hill. I am a partner at Brown,
    Goldstein & Levy, and I have dedicated most of my career to
    implementing the rights of people with disabilities.
        Imagine trying to do your job without access to the
    internet, when everyone else--your boss, your coworkers, your
    competitors--has access. Picture yourself having to call a
    customer service line every time you need information from an
    office while your competitors and colleagues get the
    information they need with a click, or waiting for a coworker
    to find time to read a data base to you or to interpret a video
    for you, while your colleagues click, scroll, and go.
        Imagine traveling an hour or more to get to a medical
    office and waiting for in-person assistance while everyone sees
    a doctor through telehealth from their home. Or imagine a
    telehealth appointment in which your child has to interpret
    your intimate details for your doctor. We all laughed at the
    scene in the movie Coda, when the daughter had to interpret the
    sex lives of her parents for their doctor, but it is not funny,
    and it is not fiction.
        In 2022, 97 percent of the top million home pages in the
    world had accessibility barriers, an average of 51 barriers per
    page, and there is no reason for this. Digital accessibility is
    not technologically complex. It has been solved since Mark
    Zuckerberg was in high school.
        Section 508 of the Rehabilitation Act has required Federal
    agencies to make their technology accessible for 24 years, but
    30 percent of the most popular Federal Government webpages are
    inaccessible, and these are ones we use all the time, like
    weather.gov, energystar.gov, and census.gov, and websites are
    the simplest form of technology to make accessible. The
    accessibility of other forms of Federal technology is dismal.
    Clients of my firm right now are dealing with trainings
    required by the Centers for Medicare and Medicaid Services that
    do not work with blind people's screen readers, and within
    intake kiosks at the Social Security Administration that are
    not accessible to blind people, and Federal employees with
    disabilities are dealing with inaccessible software programs
    that make it nearly impossible to do their jobs as well as
    timekeeping software, office machines, and online trainings
    that make their jobs more difficult.
        One might think this inaccessible technology is a relic of
    the past, but it is not. One blind employee of a large Federal
    agency for years worked on an inaccessible program that was
    central to her job, and recently the agency replaced the
    program, with a new one that is also inaccessible, and that
    agency failed to act on the employee's formal Section 508
    complaint for eight years, so far.
        In another recent case, an agency sat on a Section 508
    complaint for nearly five years, and had to be sued under the
    Administrative Procedure Act in order to act.
        The Social Security Administration, as a policy matter, is
    refusing to adopt accessible technology, insisting on wet ink
    signatures for documents to apply for SSDI benefits in spite of
    the wide availability, security, and accessibility of
    electronic signatures.
        So what to do? Section 508, in my opinion, needs six
    improvements. First, transparency. As you mentioned, the
    Justice Department is required to report on compliance every
    couple of years but has not done so since 2012. At the same
    time, GSA is collecting information on compliance but does not
    share that information with the Justice Department, with
    Congress, or with the public.
        Second, up-to-date standards. Technology develops quickly
    and accessibility guidelines keep pace, but Federal regulation
    does not. The Web Content Accessibility Guidelines 2.1 were
    released in 2018, and have not been incorporated into the
    Section 508 standards. Congress needs to ensure that the Access
    Board has the resources it needs to keep its standards up-to-
    date.
        Third, testing. Agencies clearly cannot rely on the
    aspirational, misleading, or incorrect statements of their
    technology vendors. They must have the ability to test
    technology accessibility themselves before they roll it out.
        There needs to be a significant remediation effort of
    barriers that already exist in technology, and fifth,
    oversight. Self-oversight has not worked. A Federal agency
    should be tasked with enforcing compliance with Section 508.
        Finally, accountability. The Federal agencies that are
    violating Section 508 are violating civil rights. They are
    harming taxpayers by buying technology that is not worth what
    we paid for it and by making it harder for public servants with
    disabilities to do their jobs, and vendors of inaccessible
    technology need to be held accountable to their Federal
    customers.
        Thank you very much for inviting me today and I appreciate
    your interest in this topic.
        The Chairman. Thank you, Ms. Hill, for your testimony.
        Mr. Lewis, you may begin your statement.

              STATEMENT OF ANIL LEWIS, EXECUTIVE DIRECTOR

             FOR BLINDNESS INITIATIVES, NATIONAL FEDERATION

                     OF THE BLIND, ATLANTA, GEORGIA

        Mr. Lewis. Thank you. I want to thank the honorable members
    of the Special Committee on Aging for this opportunity to
    present on this extremely important topic. I see ICT,
    information communications technology as very important because
    it creates opportunities for us to access the fundamental civil
    rights that should be extended to every American citizen.
        As stated, my name is Anil Lewis. I am the Executive
    Director of Blindness Initiative for the National Federation of
    the Blind, the most transformative organization of blind people
    in this country, and we believe that access to public services
    and public information is a fundamental civil right. We
    recognize that ICT holds the hope for us to access these
    Federal programs in a more dynamic fashion.
        In my written testimony I go through the process of
    explaining how when I went blind in 1989, the old service
    systems that were in place made it frustrating, if not
    impossible, for me to access these services. I loved the term
    that you used and I am going to use it. Now that we have moved
    to the place of the virtual front door, those old services are
    even worse, because we put more resources into creating the
    virtual front door and taken them away from the old services,
    which were mediocre at best.
        Again, the accessible ICT--and I mean accessible, not just
    information communications technology itself; if it is not
    accessible it does not work--it holds hope for us to finally
    really be able to access the information and the services like
    every other American citizen. Through screen readers that
    convert speech, the digital information on computers into
    speech for the blind person to hear, refreshable Braille
    displays like the one I am using today, which converts that
    digital information into a tactile form that I can read with my
    fingers, we can provide access and information to blind
    individuals and those with low vision, individuals that are
    deafblind, and because it is speaking the technology, those
    individuals who are illiterate and could not read, because it
    is in a digital and accessible format, it can convert to
    foreign languages, again, creating opportunities for every
    American citizen to access the programs and services that we
    should be allowed to.
        Rather than going through a litany of personal examples, in
    my testimony you will see references of how inaccessibility has
    adversely impacted a representative sample of over thousands of
    people with disabilities, and it is preventing them from
    accessing services from the IRS, the Social Security
    Administration, Centers for Medicare and Medicaid, Department
    of Education, Small Business Administration, the Veterans
    Administration, and also even Homeland Security, and the reason
    that it is impacting is not just because we cannot access the
    information and services but also we cannot become viable
    Federal employees if the systems that are used to support the
    employment are not accessible or non-vision accessible to blind
    individuals.
        I want to spend most of my time in these remaining few
    minutes not to talk about the problems that are created but
    just get people to paradigm shift and recognize that
    accessibility is not difficult. That is the big thing.
    Accessible coding is just good coding, so we are not adding an
    additional burden on the existing systems to make them
    accessible if we focus on accessibility during the design and
    development process.
        The only big problem is there is a flawed accessibility
    implementation strategy within the Federal Government. In my
    written testimony I do an analogy around typing, where
    individuals within the Federal Government are using Smith
    Corona typewriters to create documents, taking that document
    and giving it to someone who can use a word processor to create
    a digital accessible document, so of course, that person who
    runs that Smith Corona typewriter is going to think that it is
    difficult, and of course it is going to be more expensive
    because you have to add another layer. The strategy should be
    to teach that one who is working on that Smith Corona
    typewriter how to use the word processor to create that
    accessible document from the start, and then it is seamless. No
    additional cost, no additional difficulty. It just works.
        I just want to stress, well, really appreciate the fact
    that this is a very good, collaborative effort, a bipartisan
    effort to really meet this need. We know that is law. Let's
    just implement it, and the Federal Government can be an
    exemplar. One, the Federal Government can continue to strive to
    be a model employer, making sure that blind people and other
    people with disabilities have the opportunity to obtain
    employment, lateral movement, and upward mobility within the
    Federal Government.
        Two, the Federal Government can implement a procurement
    process that demands that vendors to the Federal Government
    make sure that they provide accessible technology and other
    services so that they can encourage those vendors to make sure
    that they are developing accessible information from the
    beginning. This will also affect not only the vendors'
    production of accessible materials but also the training of
    individuals in the IT profession, because a person who learned
    to program and develop, as long as they learn about
    accessibility it is just part of their everyday.
        I would just really give one quick example of what has been
    really refreshing for me lately. We know that they have been
    offering free COVID tests to every American citizen. The
    National Federation of the Blind reached out to the
    Administration and recognized that these tests were not
    accessible to blind individuals. We, long story short, have
    been working with the National Institutes of Health, the
    Administration of Community Living, and we are working to make
    sure that the whole process, from soup to nuts, is accessible,
    the website is accessible, the instructions for the kits, we
    are working with those manufacturers to make sure they are
    accessible, the kits themselves, we are working them to be
    accessible, and the beautiful part about this is twofold. One,
    people are recognizing that accessibility is not expensive and
    it is not difficult, and two, we are enculturating the thought
    of accessibility into this whole infrastructure so that every
    other product or service that NIH works with, especially when
    we are talking about telemedicine and all these other home
    health care pieces of devices that they are working with, are
    accessible, born accessible from the start, so the same insulin
    pump that a sighted person uses, a blind person can use because
    it is accessible. The same home chemotherapy that a person
    without a disability uses is the same one that a blind person
    can use who has to have chemo. It is just a win-win.
        I am just optimistic that not only will this help us access
    the fundamental rights that we deserve, but the multimodal
    resulting impact of all this technology also helps every
    American citizen, not only just in literacy and language
    translation, but someone who can see also gets comfort in the
    validation of an audible confirmation when something happens.
        Again, thank you for this time to present. I am looking
    forward to working collaborative with you moving forward to
    make the Federal Government the exemplar and introduction of
    accessibility that creates a better quality of life for every
    American citizen. Thank you.
        The Chairman. Mr. Lewis, thank you for your statement.
        As I mentioned we will be acknowledging Senators. Senator
    Blumenthal has joined us, and now I will introduce our third
    witness, Ms. Lieberman.

               STATEMENT OF JULE ANN LIEBERMAN, ASSISTIVE

                TECHNOLOGY PROGRAM COORDINATOR, TECHOWL,

                          DEVON, PENNSYLVANIA

        Ms. Lieberman. Thank you very much for this opportunity to
    speak before you today. I come to you not only as a person, as
    evident with the gray hair, of the aging community but also as
    a person who is blind. I was diagnosed in 1970 with a
    progressive vision loss, so I have gone through all the various
    stages of low vision to the point where now I would be
    considered profound vision loss or blind, and again, this does
    impact your daily life, especially when you do not have equal
    access to information.
        I work with TechOWL, which stands for Technology Our Whole
    Lives. It is an Assistive Technology Act program that is
    located within the Institute on Disabilities at Temple
    University. Our office works very hard to promote the
    independence of persons with disabilities and also promotes
    self-esteem and other personal choice opportunities.
        With that said, again, my experience teaching, I have been
    teaching for 24 years persons with vision loss, how to operate
    a computer independently, and that would be the use of
    assistive technology, as described previously, like screen
    readers.
        I have to comment. When Ms. Hill made the comment about the
    scene in Coda, it flashed on a memory of my son accompanying me
    to my mammogram appointment. We were given a form to fill out,
    and he had to ask questions. My son, I am very proud of him,
    and he is probably one of the kindest persons in the world. He
    said at the end, ``Mom, I know more about you than I ever
    wanted to know.''
        Again, equal access and equal opportunities to provide
    information is critical for anybody with any disability, of any
    age, so even though I am within the older population now--I
    guess you could say that--I plan to continue working for some
    time, and having access to this information, not only for
    myself but also for the customers that I serve, I provide
    information assistance at my office and so very often I have to
    direct people to finding locations on the internet, over the
    phone, and it really bothers me when I know, in fact, I cannot
    get that information completely. Sometimes there are
    roadblocks.
        As an example, these past few years we have all been in a
    crisis situation, dealing with health inequities and also the
    health situation as a result of COVID. I am a person that
    thinks information is power, and I rely on reliable
    information. I would hope that the Federal Government and its
    resources, like at the CDC, would be able to provide me with
    accurate information. You do not want us to merely be relying--
    as their best efforts are--with news media and/or social media
    to provide us with information that may or may not be accurate,
    so we look for these resources that we would hope that would
    ensure accurate information.
        I tried to find the prevalence of COVID activity, and this
    was in the spring of 2020, again, in my region, my State, and
    my county, and it was presented in a graph with no description,
    so it was very frustrating. I could get to one point, to where
    I could actually identify where I lived, and everything was
    represented in a graph which provided me no information at all,
    and so, you know, for me, I had to rely on other sources.
        Now I am very, very fortunate that I have a very supportive
    family, incredibly supportive family, so as a routine, my son
    would come up--we were both teleworking. Obviously, our offices
    were shut down, and as a routine he would come up at least once
    or twice a week, at lunchtime, sit down with his computer, and
    say, ``Okay, Mom, here are the updates.'' He would read them
    aloud to me, and it provided assurance to both of us and helped
    us make decisions on our activities. Is it safe for me to go to
    the grocery store? Is it safe for me to go to church?
        The things that are important to us, we need to know that
    information so that I know that, okay, I am safe if I wear my
    mask or what other guidelines are there, but having that
    initial information of how often this is happening in my
    neighborhood is incredibly important.
        You know, going down then to the spring of 2021, it was
    wonderful that we had the availability of vaccines.
    Unfortunately, when I tried to research how I could get a
    vaccine and make a vaccine appointment the sites that were
    directed by the CDC, including some providers, in order for you
    to access the information on availability of vaccines you had
    to click on a map.
        Okay, pointing and clicking is not an option for me. If it
    is a graphical representation and the only access you have is
    clicking with a mouse, it is no access, and then if I did get
    any information I would not be able to make an appointment.
        So out of frustration, I posted on our office, the
    Institute on Disabilities, listserv, what am I going to do
    about this? I need to find a vaccine, and fortunately a very
    respected manager--Jamie, thank you--sent me a phone number at
    the Area Office on Aging and Disability and she said, ``I
    believe there are starting to have appointments in your area.''
    It took me five minutes to schedule an appointment. I did not
    have that information otherwise. There was no information of
    calling, you know, that agency anywhere, so that I could make
    that appointment myself.
        With that said, it was a very positive experience that I
    had good relationships with my coworkers and a very supportive
    family, but that is not the case for everyone. I do work with
    individuals that may be vulnerable, for example, that they are
    blind and they are relying on someone that perhaps is less
    trustworthy or abusive. You do not want them to be providing
    that information to someone when they are seeking support
    services from the government. I really do not think that is
    something that should be expected, but again, it does put
    people in a very risky situation.
        Again, I am fortunate that I do have a great support
    network, but that is not the case of many of my colleagues. I
    am active in the Pennsylvania Council of the Blind. Many of my
    colleagues do not have that option. They live alone, and they
    do not have those resources, so again, I am fortunate that I
    do, to a point, or it stops, and that is where I am hoping that
    these actions that you are taking today in this conversation,
    you can carry it forth, and like my colleagues here on right
    said to me, that it follows through. If you start with one,
    make some corrections at the VA, and then other websites to see
    how it works. Then they can become accessible--likewise in the
    commercial market. It is going to happen.
        Again, it is something that is not hard to do. There are
    guidelines. Most people, when they create a website that is not
    accessible, it is not because they are intentionally trying to
    lock me out of information. They just do not understand that is
    a need, and so, therefore, they do not know.
        In my written testimony I have some reference of where you
    could find about the website accessibility guidelines that are
    available, so that they can review, and also that there is
    information about how to get support services in order to do
    that.
        I do caution our Federal websites----
        The Chairman. Ms. Lieberman, I just want to make sure we
    can move on to our next witness, if you can wrap up.
        Ms. Lieberman. Very quickly, yes. I just wanted to caution
    you not to take advantage of the commercial ones that say, ``We
    can fix your accessibility.'' Those overlays that they provide
    use artificial intelligence that, unfortunately, as much as
    this has evolved, it is not the answer. They cannot guess what
    my needs are. We have to be able to use our software
    independently.
        Thank you for your attention.
        The Chairman. Thanks, Ms. Lieberman.
        We will now conclude our witness statements with Mr.
    Holmquest. You may begin.

     STATEMENT OF RONALD HOLMQUEST, RETIRED AND U.S. NAVY VETERAN,
                     MOUNT PLEASANT, SOUTH CAROLINA

        Mr. Holmquest. Good morning Chairman Casey, Ranking Member
    Scott, and distinguished panel. Thank you for inviting me to
    speak to the Senate Aging Committee about my experience with
    telehealth and the VA.
        You can probably tell I am not a native of South Carolina.
    I spent most of my life up north before moving here seven years
    ago. There are a lot of good reasons to live in South Carolina.
    I moved here to be close to my son, daughter-in-law, and
    granddaughter, who is now 10 years old. I have the pleasure of
    helping to take care of her a few days a week.
        When I moved to South Carolina in 2015, South Carolina
    veterans welcomed me. I was invited to the Port of Charleston
    for the commissioning ceremony for the USS Ralph Johnson, a
    guided missile cruiser named after a Marine from South Carolina
    who posthumously received the Medal of Honor for his heroic
    actions during the Vietnam War. Ralph Johnson used his body to
    shield two fellow Marines from a grenade, absorbing the blast
    and dying instantly. I am wearing this baseball cap today in
    his honor.
        South Carolina veterans recommended that I check into the
    VA. I have been with the Charleston VA since 2016. What I did
    not expect before I moved here was the excellent health care I
    would get at the Ralph H. Johnson VA Health Center, which is
    also named after that same heroic Marine.
        A couple of years ago, the VA invited me to sign up for
    telehealth, and I was skeptical. I have lots of severe medical
    problems, but I never signed up for VA health care before 2016,
    because I thought it was for veterans who were hurt and maimed
    in Vietnam and other wars. I figured they needed it more than I
    did.
        I served in the U.S. Navy during the Vietnam War, but most
    of my active service was in Japan, where I served as a
    communications technician. A highlight was attending a
    performance by Bob Hope. After being honorably discharged from
    the Navy, I eventually ended up in Montpelier, Vermont, where I
    worked in information technology.
        I also served as a volunteer EMT for about a decade in Fire
    and Rescue. In those days, all we had was bottled oxygen to
    keep people going until the ambulance arrived. We did not have
    all the modern technology they have these days. Sometimes the
    ambulance got lost on the back roads of rural Vermont. I guess
    it was tough to navigate when the cows moved.
        With telehealth, the VA can manage my complex chronic
    conditions very well. The VA assigned me a telehealth case
    manager--what a pleasure. Mine is an RN with a Bachelor of
    Science in Nursing who knows her stuff. Her name is Frances
    Santana. I thought that they were all vets, but not all of them
    are, and they always say, ``Thank you for your service.''
        The Ralph Johnson VA Health Center is a teaching hospital,
    so some of the docs are from the Medical University of South
    Carolina, so you get the best, smartest medical staff to be
    found.
        A function of telehealth is that they watch after you. I
    send my vitals to my RN daily and if there is a problem you get
    a call immediately. She has direct contact with docs, fellow
    RNs, and other providers, and will get answers to your problems
    or education for you on medicine and procedures. She gets
    problems resolved for you.
        A big plus at the VA is that one computer system is looked
    at by all, including docs, RNs, and medical staff. When you
    have an appointment, your provider has all the necessary
    information.
        I have many decades of experience as a computer programmer
    from the early days of the industry. It is so important to have
    computers fully and properly used to benefit patients.
        Another point is that telehealth and technology have made
    care more personal, not less. I have five different
    cardiologists who treat me. When I have questions about a
    medication or why I have been taken off of a medication, I
    would pick up the phone and call Frances. She checks with the
    doctor and tells me they prescribed it because other
    medications have adverse reactions to my existing medications.
        I also use MyHealtheVet to make appointments. It is very
    effective.
        Telehealth is critically important to veterans' care. All
    veterans should have this opportunity. Telehealth and the VA
    need to stay for the benefit of all vets. It would be a shame
    to lose these valuable assets.
        Thank you for letting me share my story.
        The Chairman. Mr. Holmquest, thanks so much for your
    testimony and thank you for your service. We are grateful, and
    we are grateful you are with us today.
        I will now turn for our first set of questions to Senator
    Blumenthal, and we are joined by Senator Braun.
        Senator Blumenthal. Thank you very, very much, Senator
    Casey, and thanks to you and Ranking Member Scott for having
    this hearing, which is so important. Thanks to all of the
    experts who have come to talk to us, and a special thanks to
    you, Mr. Holmquest, for your service.
        I gather you are now in South Carolina but you lived for a
    long time in Vermont, and as a fellow New Englander I am
    especially grateful for your personal insight into how
    telehealth and the VA, this technology, is making your life
    better, and I would agree with you that South Carolina is a
    good place to live and it is also a nice place to visit. Thanks
    to Senator Scott for inviting you to be part of this proceeding
    and sharing your story, which is really powerful because I
    think you have shown us how telehealth, and I am quoting you,
    ``Telehealth and technology have made care more personal, not
    less.'' I think that is a really important point.
        I am on the Veterans Affairs Committee and the Armed
    Services Committee. Telehealth really has broadened and
    deepened the kind of care that people have available,
    especially for people who have disabilities and may not be able
    to travel to the VA hospital in West Haven or in Newington, but
    can get care at home if they have access to the technology.
        In Connecticut, 21 percent of all adults live with a
    disability, and 27 percent of all veterans--27 percent of all
    veterans in our state--have a disability, so this kind of
    technology is very, very important to them, and I wonder if you
    could tell us a little bit, Mr. Holmquest, talking about maybe
    some of your buddies in South Carolina, how access to this
    technology is very important to them, and maybe some of the
    difficulties they have encountered in accessing telehealth.
        Mr. Holmquest. I think the access to telehealth, for
    myself, if I had a question I would not know who to call as far
    as a doctor was going to be concerned, but I could call Frances
    and get her to be contacting the appropriate doctors, the
    appropriate services that you might need, get those services to
    give me a call to set up an appointment to followup on what is
    needed for my care. That was the biggest assistance for me was
    to have that synergy where she could talk to other people. I
    would not know who to call, to be honest with you, but she
    could, and she handles that for me very well. It is just
    fantastic. If I have a problem of any kind my phone call is to
    her first, and she can solve the problem for me.
        Senator Blumenthal. You mentioned you have access to five
    different cardiologists, some of the best in the State, maybe
    the Nation.
        Mr. Holmquest. Yes, absolutely. I came down with some heart
    problems, and because this is a teaching hospital there are VA
    doctors, MUSC doctors that all get together. They have their
    meeting in the morning, when they talk to you when you are in
    the hospital. There is a whole bunch of them that come in there
    and discuss what is going on, and when they leave there they
    have a plan of attack on what is going on.
        In fact, one day they said, ``Oh, by the way, we have
    discussed this and we think you need a defibrillator implanted
    in you.'' I said, ``Wait a minute. Am I that bad?'' Their
    decision was it is better to have a defibrillator available
    than have to wait for one, so I was very pleased with that. I
    went along with what they said.
        I trust every single doctor and nurse at the VA. They are
    just fantastic. The people that are with the VA are dedicated.
    The people that help them out, the nurses and so on, everybody
    is so dedicated and qualified to do their job here. It is
    unbelievable.
        Senator Blumenthal. Well, we are trying to push the VA to
    do even more of that kind of telehealth, and the present
    Secretary of the VA, Dennis McDonough, is very much on board
    with that approach. I am going to pass along your insights and
    your story to him, and thank you very much for joining us
    today.
        Two of my sons have served, one as a Navy SEAL, the other
    as a Marine Corps combat infantry officer in Afghanistan. They
    have made use of VA services from time to time, and I hope it
    is available to even more people in South Carolina, throughout
    the country. Thanks to Chairman Casey and to our Ranking
    Member, Senator Scott, for this hearing today. Thank you.
        Mr. Holmquest. Thank you, sir. Thank them for their
    service.
        Senator Blumenthal. Thank you.
        The Chairman. Thank you, Senator Blumenthal. I will turn
    next to Ranking Member Scott who will share his time with
    Senator Braun, I am told.
        Senator Tim Scott. Thank you, Chairman Casey, and thank
    you, Senator Blumenthal, for your kind comments about the
    importance of living in South Carolina, and for visiting South
    Carolina, if you have to represent other states, and thank you
    also for your time and your service and your dedication on the
    Veterans Committee as well as the Senate Armed Services
    Committee. Certainly working in a bipartisan coalition or
    fashion is really important for our country to see and have
    here our witnesses watch that. Hopefully we will improve just a
    little bit and people's perception of how Congress or the
    Senate actually works together.
        Mr. Holmquest, thank you for your comments. I am certainly
    proud to have you in South Carolina and thank you for your
    comments about Mr. Johnson as well, Ralph H. Johnson, who gave
    his life for the salvation--saving the lives of two other
    Marines was such a powerful story. I was at his commissioning
    of the USS Ralph Johnson in 2018. A powerful story that we
    should all read about, and I thank you, Senator Blumenthal, for
    focusing many of your questions on the importance of telehealth
    and how telehealth is actually bridging a gap and bringing
    expert care to where the person who needs it the most.
        With your questions I am going to go ahead and defer to
    Senator Braun, since you and I both were going to focus on the
    telehealth environment. Senator Braun, I will give you the
    balance of my time.
        Senator Braun. Thank you, and thank you, Mr. Chairman, as
    well.
        My question is going to be for Ms. Lieberman. Before I got
    here in Senate I ran a logistics and distribution company for
    37 years, and I remember vividly, early on, how crude our
    systems were when we were starting to automate. I think it
    might have been a Radio Shack system or something when we first
    started.
        I do know that to be competitive in any business now, and
    especially in one like ours, when it is sprawling--it was so
    little for so long--technology, and being on the leading edge
    was the differentiator, in many cases, whether you were going
    to be successful in business or not.
        Two of my four kids, my sons, started about 15 years ago
    right when we were getting some size, and we had to say either
    we are going to embrace technology or we are going to be left
    in the dust. Thank goodness my older son, he got schooled in
    it, is great at it, and we decided to do it, and he and my
    younger son now run the company with one of my two daughters.
        I was listening to the testimony, and it is so reminiscent
    of what, in the early days, where we were not quite doing
    things the way they should be, mostly due to budgetary issues,
    and since I have been here in the Senate our technology is
    pretty good here for Senators, and I am sure over in the other
    side for Representatives, but I get complaints often when we
    are interfacing with the IRS, with the VA, and then hearing
    your testimony, especially in trying to access, being impaired
    in the way that you have to deal with it, you know, it is
    really kind of almost shameful.
        Because when you have got all these agencies spending this
    much money, yet you are having simple issues of connectivity,
    you look at the stats here which the Information Technology
    Innovation Foundation, 30 percent of the most popular Federal
    websites did not pass an automated accessibility test for their
    home page. I mean, that is almost laughable if it would not be
    so sad.
        So please elaborate on, in your particular case, what you
    have experienced, and then maybe give me a few ideas, give us a
    few ideas on what minimally needs to be done to see a
    difference.
        Ms. Lieberman. Sure. I think, first off, understanding how
    someone that is blind is accessing a website is the way things
    are logically arranged. Screen readers technically will read
    from left to right, up and down, and they will read everything,
    so when things are designed, especially those that are low
    vision, that it is cluttered and things are low contrast, for
    example, that can be very difficult for them to navigate and
    also for the screen reader to interpret the information.
        So what most screen readers will do--that is the software
    that I use to access--it will then allow us to be able to
    navigate quickly to various section of information, so if a
    website is designed with good structure, with headings and with
    well-labeled links--when I say well-labeled link, when you talk
    about those automated accessibility checkers, I am kind of
    burning it underneath because sometimes they will say
    everything is fine or your links are labeled, but it is not
    helpful when they are labeled ``click here'' or ``see more,''
    because it is taken out of context in that list that the screen
    reader will do. It is very, again, disconcerting because I do
    not know what it is referring to, so having things that are
    well-structured, well-labeled, well-described, so graphics that
    are important.
        I will have to commend NASA, the most recent ones with the
    images from space is a delightful visit for somebody who is
    blind, because it does give us a great appreciation of what
    these images, and very well-crafted descriptions, so there are
    some organizations that are getting it, that understand it.
        Again, I mentioned the AI, the artificial intelligence that
    is being applied. That is not a good way of going about it. If
    you want to think about having accessibility you start with the
    basics of accessible design, so there are, as I mentioned,
    there are guidelines that you can refer to, and the best thing
    that I have found at my office they like to do is they pass it
    by, if Jule Ann can read it then it is okay, so a lot of times
    I will be asked by other organizations.
        In fact, I recently provide technical assistance for the
    Southeast Pennsylvania Transportation Authority, or SPTA, on
    the accessibility of their website, and I provided them
    examples with my screen reader aloud, so they can hear it, and
    what the experience was.
        So yes, there is information out there on how you can
    create it. Good structure from the beginning, good design saves
    a lot of time and remediation. You do not want to wait until a
    complaint.
        Senator Braun. That all makes sense, and I think for as
    much money as we spend and for all the good things we try to do
    through our various agencies, and as important as high-speed
    anything is, when you have got that and you are not formulating
    the right home pages, the right techniques, I would welcome any
    of you to make sure to give us--on the side of getting ahold of
    us. My Senate office, if you are having trouble doing it
    through the agencies, call my Senate office. Tell my staff, and
    we will get in touch with those various agencies to see why
    they are not maybe putting the resources, putting the effort to
    it, when that is so highly recommended. It is so great when it
    does work, where you do not have to deal with the frustration
    of the basics, so keep that in mind. Thank you.
        Thank you, Mr. Chairman.
        The Chairman. Thank you, Senator Braun.
        I will also turn back to Ms. Lieberman for a question and I
    will include it in this question. I will direct it also to Mr.
    Lewis. Both of you have had personal experience living with a
    disability, as your testimony indicates so clearly. You have
    also both had decades of experience working with people with
    disabilities. You have seen both ends of it, hearing from those
    who have had their own experiences and having your own.
        The hearing we are having today is, as I said earlier,
    particularly relevant because we celebrate this week the 32-
    year anniversary of the Americans With Disabilities Act, and
    the goal of the law is then-President Bush said, to quote,
    ``Let the shameful wall of exclusion come tumbling down.'' That
    wall of exclusion is still, unfortunately, so evident in some
    of these issues we are talking about today.
        Thirty-two years later, people with disabilities still face
    these walls of exclusion because of how technology has advanced
    and how we have not kept up with making that technology
    accessible, and of course, we are focused today on Federal
    agencies.
        I would ask both Ms. Lieberman and Mr. Lewis, can each of
    you share an example of people that you have worked with who
    have experienced information technology barriers and the impact
    that it has had on them.
        Ms. Lieberman. Do you want to go first?
        Mr. Lewis. No, I am a Southern gentleman.
        Ms. Lieberman. Oh, a Southern gentleman. Well, thank you,
    Southern gentleman. I am from Pennsylvania so we talk a little
    fast.
        Actually, Senator Casey, I did forget to mention that my
    formative years were spent in St. Clair, which is a small town
    in Schuylkill County.
        The Chairman. Schuylkill County, right.
        Ms. Lieberman. Oh yes. I am a coal-cracker too, my
    background, but I lived 40 years outside of Philadelphia in
    Chester County.
        To answer your question as far as the people that I have
    worked with, access is critical, as I have mentioned several
    times, and some of the barriers that they have, if a website is
    designed, oh, that you just need to tab, if you open up most
    websites, especially Federal websites, I believe when I
    attempted to look at the IRS one I think the opening page had
    over 200 links, so if you use your Tab key it is going to tab
    through each one of those links, so there has to be a way so
    that you can structure it so that you can get to things very
    quickly to get your answer, because quite frankly, time is not
    only money but time is also patience, so how much patience do
    you have?
        I have had several individuals that will tell me, ``Oh, I
    just gave up because it was too tedious. It was too hard to get
    to the information that I needed,'' and that seems to be one
    of, I would say, the carryover in most cases with all
    disabilities, and the older population. Our aging population,
    they want an answer now. They do not want to have to go through
    15 steps in order to get to that answer. They want to have that
    information as easily found as possible, so that is pretty much
    the experience I have had with others, as well, on websites,
    not just Federal websites but in general.
        Mr. Lewis. I would have to offer that with respect to
    websites, we have a host of different examples of individuals
    that have tried to access information from the Federal
    Government website, and it is not even just the factor that you
    go to that site and it is inaccessible. It is to the point
    where there is a little bit of accessibility, so you can go
    through the process of actually providing essential information
    to get to the place where you need to get the information that
    you are requesting, and after you go through the tedious
    process of trying to maneuver through, and you are finally
    getting to that place where you are able to click this link
    that gives you access to this document that you have been
    searching for, for about an hour, you click it and the
    resulting document is inaccessible. I mean, it like the virtual
    front door is open and you walk in, and there are other doors
    that are still closed.
        The one I really like to highlight, because we are talking
    about, again, information communication technology--and let me
    say for the record, I am a believer in the potential. My
    undergraduate is in computer information systems, and I have
    been, for years, talking to individuals that this is not very
    difficult, because in the world of digital information it all
    boils down eventually to 1's and 0's, and if we focus on doing
    internet development and design process, we can make it
    accessible. It is not a problem. We just have to make sure that
    it is intentional and not done after we have done this
    wonderful creation of something, and then we say, oh, now we
    should make it accessible. No. That is why it is difficult.
    That is why it is expensive.
        Social Security Administration, trying to reach
    efficiencies in dealing with the old-school service system,
    where people have to go into the office to get access to
    services, and the kiosk system, which I have credibility. It is
    much better than going and just pulling a number. You can
    provide information that allows them to streamline the type of
    service that you specifically need. You just simply go to the
    kiosk, you enter your information including your Social
    Security number, your reason for the visit, boom, and you get
    associated not only just with a number but with the number that
    goes to that person that is going to help you with that
    specific issue.
        The only problem is as a blind person when I go to that
    kiosk it is inaccessible, so either now I have to coordinate my
    visit to the Social Security office with a friend or family
    member that I trust, or because it is not staffed by the Social
    Security Administration staff, I have to ask a total stranger
    to enter my Social Security number into this kiosk in order for
    me to get the same services.
        So yes, there are a host of examples we can give, but
    again, I would still like to continue to focus on the fact that
    the knowledge for accessibility is there, the tools already
    exist. It is really just about the efficient and ethical
    implementation of these strategies, and then that way all the
    money we are spending on DOJ complaints and the four-year wait
    to get access to services, all that time, energy, and resources
    can be refunneled into training the people who are developing
    the information delivery systems, and then it is a win-win for
    everybody.
        The Chairman. Thanks very much, and I will turn next to Ms.
    Hill. As you know, the Department of Justice is required to
    issue a report on the Executive branch's compliance with
    accessibility requirements in Section 508 of the Rehabilitation
    Act, which you were highlighting and you know so much about.
        This report has not been completed in the past ten years.
    As I mentioned, Ranking Member Scott, Senator Burr, and I
    recently joined together to call on the Justice Department to
    begin issuing these reports again. We were joined by Senator
    Durbin, Senator Grassley, Senator Murray, Chair of the Health
    Education Labor Pensions Committee, and Senator Duckworth.
        In your view, why are these reports important, number one,
    and how will Pennsylvanians who rely on government services
    like Medicare, Social Security, and the VA Health System
    benefit from these reports being made available again?
        Ms. Hill. Thank you. Yes, transparency is really important
    in this field because without it agencies are tempted to not
    comply and wait to see if they get caught by someone who
    encounters the barrier. This transparency encourages agencies
    to take accessibility seriously at the beginning of a
    technology purchase, when it is easy and inexpensive to do,
    rather than wait and have to do fixes that are expensive and
    time-consuming, and Pennsylvanians and others will benefit not
    only from that cost savings but from the improved level of
    customer service that all that technology will provide if it is
    accessible from the beginning, not only for people with
    disabilities who will be able to count on being able to use it
    but as Mr. Lewis has said, accessibility is good design, so
    everyone with and without a disability will benefit from that
    additional good design, and the Federal Government's purchase
    power will improve those vendors' ability to have accessible
    products as a matter of course, and that ripples out into the
    rest of the world.
        The Chairman. Well that all makes sense and it is all the
    more reason why we have got to keep pushing every agency, but
    in this case to push the Department of Justice to begin to
    issue those reports again after such a long period of time of
    not issuing those reports.
        I will turn back to Ms. Lieberman. In your role as
    Coordinator of the Assistive Technology Program in Pennsylvania
    you come in contact with many people with many different types
    of disabilities. We know that there are over 61 million
    Americans in our country with a disability, and almost two-
    million of those are in the State of Pennsylvania.
        As I mentioned earlier, the pandemic has accelerated the
    Federal Government's adoption of electronic information and
    technology communications to share information and provide
    services online. That is a good thing that those services are
    available online. Critical benefits from the Federal
    Government, such as Medicare enrollment, now primarily take
    place online.
        Can you tell the Committee why it is essential to ensure
    online services, especially Federal online services, are
    accessible?
        Ms. Lieberman. I think, well, besides the fact that it is
    my right, as a citizen of the United States, to expect that I
    can obtain services when it is need, something like Medicare,
    for example, it is vital that I would have that access to that
    information and be able to complete it independently.
        Things that would be of note would be when we are requested
    to complete a form online that all the form fields are labeled.
    They may show up on the screen but the screen reader does not
    have that information so it is not telling me, so I just get
    blank edit fields.
        So for me, to quickly, efficiently apply without having to
    ask somebody else to help me, that is the type of barriers that
    I see as well, with individuals that contact our office, that
    they seem to have issues. Is it because the technology is too
    complex, so they think, or is it the website is not accessible?
    Sometimes I have to do a little detective work to try it out
    myself, to see if, indeed, if it is, again, operator error or
    is it an error literally in the design of the website.
        I have encountered that a few times over the years--I have
    been there nine years--and I would say I can think of 25 cases
    where people have asked me to get that assistance for them in
    order for them to access information on the internet, whether
    it be Medicare or any other location on the internet.
        I do not know if I answered your question. Hopefully I did.
        The Chairman. You did, and thank you for that testimony. I
    appreciate it.
        We will now turn to Senator Rosen for her questions.
        Senator Rosen. Well, thank you so much, Chair Casey. I
    really appreciate you bringing forward this hearing, and thank
    you to everyone for being here, digitally, and we just
    appreciate what you have been doing and how we can help you.
        I want to talk a little bit about digital equity because
    the Bipartisan Infrastructure Law that Congress passed last
    year, it is the most significant Federal investment we have
    ever made to close the digital divide, something that is really
    important.
        I was proud to be one of the group of Senators that helped
    draft the key portions of the law, which included critically
    important digital equity provisions. The past three years have
    shown us how critical access to affordable, high-speed
    broadband is for everyone. The pandemic has shown us that, but
    speed and low cost are just part of ensuring digital equity for
    all individuals. Digital literacy, access to devices that meet
    users' needs, applications that enable and encourage self-
    sufficiency and participation--well, they are all components of
    ensuring digital equity and inclusion.
        So in drafting the equity provisions of the infrastructure
    law Congress did make it a priority to improve the digital
    equity as well, including for individuals with disabilities.
        So I would like to ask Mr. Lewis and then Ms. Lieberman,
    how are your organizations working with NTIA and the State
    broadband offices to ensure that these digital equity programs
    that we created here in Congress are promoting equity among our
    aging, disabled, and our veterans communities, and if you are
    not collaborating, this is something that we should consider
    doing. Do you need help? Can you just speak to that?
        Let's start with Ms. Lieberman.
        Ms. Lieberman. I am very fortunate where I work. TechOWL
    has participated very much so in health equity issues in two
    areas. Initially, we received some money from the Area Office
    on Aging funding, and with that we expanded our lending library
    so that we could introduce iPads to seniors so that they could
    have that same access to telehealth, to Zoom, as we had
    previously heard described, so they could have all that kind of
    access, and we put it into our lending library and made the
    decision for them to borrow it for rather extensive time
    periods so that they can explore whether that works for them
    first, because one of the things that we have noticed over the
    years, assistive technology can be abandoned. If people have
    not had an opportunity to try it first, then they have a
    tendency to purchase something or have something provided and
    it sits in the drawer. The last thing we wanted to do was to
    have this resource not used properly, so that is the intent
    that we had with addressing the need initially.
        We now subsequently have received funding so that we can
    expand the health equity to providing tablets for individuals
    that have no computer access in the home, and that, again, is
    not necessarily disability based but it could be anybody that
    does not have that access in the home, and that program is
    going like gangbusters with applications from across the State.
    I think the latest I heard was that we were up to like 1,200--
    but do not quote me on the data--applications that we have
    provided for the Android tablets.
        Senator Rosen. We have just a minute left. Mr. Lewis, could
    you speak a little bit? Are you having cooperation with other
    offices to be sure that we are doing some of the same things
    that Ms. Lieberman spoke about?
        Mr. Lewis. Sure, I will be brief, and just State that I
    will be reaching out to you after the hearing to see how we can
    work with those entities, because as a nationwide organization
    of blind individuals we have been focusing mostly on working
    regarding broadband access with some of the commercial
    providers, Comcast, et cetera, some of the innovative programs,
    they have been doing to get in the rural areas, but I would
    like to explore other ways that we can work with some of the
    entities that you just mentioned.
        Senator Rosen. Well, thank you. I really appreciate that.
    We will get together.
        I know I only have 42 seconds left. The last thing I wanted
    to just ask, and I will take the response off the record, is
    driver-assisted technology for disabled veterans, because in
    Nevada we have 225,000 veterans, but we are getting all this
    new technology that you do not have to drive the car, and I
    think our veterans really deserve that, and so we are
    developing legislation to provide tax credit to all disabled
    veterans, no matter what level of disability, to cover the cost
    of driver-assisted technologies, whether they are just helping
    them to park or cruise control, the mirrors, any of the
    features that we have. It does not have to be a driverless
    vehicle.
        Mr. Holmquest, we are going to ask you this question. You
    can submit that answer to us off the record. I am not in the
    room so I am sure there is somebody after me. Otherwise, if
    Chair Casey says there is not we can have you answer.
    Otherwise, I will take it off the record.
        The Chairman. It is perfectly appropriate to answer it if
    he would want to.
        Senator Rosen. Oh thank you. Mr. Holmquest, how do driver-
    assisted technologies and all the related supports help level
    the playing field for disabled veterans and their quality of
    life after they return home?
        Mr. Holmquest. I am not clear on the driver-assisted cars.
        Senator Rosen. Well, maybe not where they drive you by
    themselves, but I know that there are new technologies that
    will help you park, right, assisted parking, or there are
    special mirrors so you can see the backup cameras, they can
    help you notice if someone is getting close and merging, so
    that is what I would like to ask you about.
        Can you hear me okay?
        [No response.]
        Senator Rosen. That is okay. We can take it off the record.
    Okay.
        The Chairman. Mr. Holmquest, yes, if you want to you can
    provide an answer in writing, or if you want to answer now.
    What is your preference?
        Mr. Holmquest. I would take it off record if we can because
    we just got interrupted by a loud-speaker here.
        The Chairman. Oh, okay.
        Mr. Holmquest. I did not hear what you were saying. I am
    sorry.
        Senator Rosen. Okay. Well, thank you. All right. Well,
    thank you. Thank you, Chair Casey. I appreciate it.
        The Chairman. Senator Rosen, thanks very much, and just for
    everyone to know, and Mr. Holmquest, we often have questions
    that get submitted for the record and they are answered in
    writing, that becomes part of the record after the hearing is
    over, so there is nothing unusual about that, and we appreciate
    his willingness to do that.
        I know we have to conclude a little bit early today, but
    before we do that I just wanted to pose maybe one more question
    to Ms. Hill about the law. Section 508 of the Rehabilitation
    Act, as we cited before, establishes a floor from which experts
    at the Access Board set standards for accessible information
    technology for the Federal Government.
        Despite the good intentions of this law, Section 508, there
    are serious accessibility gaps across the Federal Government.
    Today's hearing has, if anything, reinforced that fact. Are
    there changes to Section 508 that would bring it in line with
    the time, so to speak, after a quarter century of this law
    being on the books?
        Ms. Hill. Thank you for that question. I think we have
    learned a great deal over the last 24 years about how
    implementation of accessibility in technology works, and one of
    the things that we have learned, both in the private sector and
    in the Federal Government, is that self-monitoring does not
    work, and so a Federal agency should be tasked with enforcing
    compliance with Section 508. The Federal Government experienced
    a similar issue with the Architectural Barriers Act back in the
    1960's, and the Access Board was eventually given enforcement
    authority under that act, and the same thing could happen here.
        In addition, right now the vendors of inaccessible
    technology, who may be not giving their clients the full scope
    of the inaccessibility of their technologies, need to have
    methods of accountability, so Federal agencies need to be able
    to take action against those vendors and to rescind contracts
    and take other actions, and that is not available, or not clear
    right now in Section 508.
        The Chairman. Well that is helpful to have that because we,
    obviously, want to make changes to law where we can. Mr. Lewis
    said it pretty well in his opening, and I am quoting from his
    very simple, blunt statement. He said, ``Accessibility is not
    that difficult. It is the law. Let's just implement it.''
    Sometimes the challenge is implementing the law appropriately,
    and we have got some shortfalls here, but in addition to
    implementation of existing law we want to consider ways that we
    can, in fact, change the law.
        I just have one more question that my staff has given me,
    and I want to make sure that we get this on the record. The
    Blind Veterans of America first brought Federal accessibility
    shortfalls to my attention way back in 2018. I did not realize
    it was that long ago. They remain concerned that the VA is
    still far behind.
        Ms. Hill, I am going to turn to you again because these are
    questions we should have answered on the record if we can. You
    have received the report required by the VA Website
    Accountability Act, the law that I passed with Senator Moran
    that I made reference to earlier. We know the VA is answering
    questions about how they will move the ball forward, but what
    should we be looking for as markers of success? If you could
    give us some free guidance on that.
        Ms. Hill. Certainly. If an entity is planning to achieve
    success in accessibility there are a few things they have to
    do. One is stop digging into inaccessibility. Stop bringing in
    new technologies that are not accessible, and that involves not
    taking your vendor's word for it but testing your own
    technology before you roll it out, and that involves both
    automated and user testing.
        The other things are a substantial remediation effort, and
    that involves planning, identifying what is wrong, which really
    requires an audit of what is wrong, and then prioritizing when
    you are going to fix things in order--what is most important to
    fix--scheduling deadlines, assigning staff with responsibility
    and authority to get the job done, and paying attention to
    whether the deadlines are met, and then consequences for when
    the deadlines are met, and in the things that I saw from the
    VA, none of those elements were present.
        The Chairman. Well that is very helpful for us as we
    discharge one of the obligations of the members of the Senate
    and committees in the Senate, and that is oversight, is one of
    the changes that you have suggested.
        I want to thank our witnesses for their testimony and for
    their willingness to bring their professional and personal
    experience to this hearing so that we can make changes and hold
    Federal agencies and hold our government accountable, and to
    make sure that there is accessibility for people with
    disabilities, in all kinds of settings but especially in
    settings like the Veterans Administration.
        Today's hearing shows that there is a long way to go before
    Federal technology is fully accessible for people with
    disabilities, for older Americans, and for veterans. It also
    shows that Congress needs to take a close look at Section 508
    of the Rehabilitation Act to see if changes are needed. In the
    meantime, there is a path to ensuring websites and other
    technologies are accessible with existing laws, as I mentioned
    earlier.
        I plan to work with the Biden Administration to make sure
    it continues prioritizing improved disability access to Federal
    technology and online services. A good first step would be for
    the Department of Justice to begin issuing, again, the biennial
    accessibility reports required by Section 508 of the
    Rehabilitation Act. This will provide taxpayers with an
    important status update that is at least eight years past due.
        As we move forward, let's keep the disability community's
    long-held motto of ``Nothing about us, without us.'' We should
    keep that front of mind and make sure that they have a seat at
    the table when it comes to accessing important information that
    they need and that their families need.
        Ranking Member Scott has submitted a closing statement for
    the record, and with that I want to mention for the record as
    well that if Senators have additional questions for the
    witnesses or statements to be added, as I mentioned earlier,
    the hearing record will be kept open for seven days, until next
    Thursday, August 4th.
        Again I want to thank our witnesses for their testimony and
    for their work in preparing for this hearing and being with us
    today, and this concludes today's hearing.
        [Whereupon, at 11:25 a.m., the Committee was adjourned.]

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                               CLOSING STATEMENTS

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                     CLOSING STATEMENT OF SENATOR
                       TIM SCOTT, RANKING MEMBER

        Thank you, Mr. Chairman, and the witnesses for your
    testimony. Today's hearing highlighted how we can continue to
    develop policies that enable our seniors, veterans, and those
    with disabilities to remain connected.
        I will continue to prioritize legislation that grants all
    Americans access to telehealth services. The Telehealth
    Modernization Act is an important step to ensure that the tens
    of millions of Medicare beneficiaries and others who have
    relied on telehealth during the COVID emergency can continue to
    receive these services.
        I also join Chairman Casey in looking forward to the
    responses from the VA and DOJ regarding our letters on
    improving website accessibility.
        Thanks to today's witnesses, Congress is better informed to
    take steps to improve access for our seniors, veterans and
    Americans with disabilities. Thank you all for your testimony
    today.
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                                    APPENDIX

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                          Prepared Witness Statements

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                            Questions for the Record

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                           Statements for the Record

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