[Greater-baltimore] Annapolis Fact Sheet 1

Mon Jan 14 14:27:09 UTC 2013

Hello All-

See below. Here is our first Annapolis issue. Please review. Send me your
name off list if you are attending on January 17.

Thanks,

Sharon

Subject:           Access to Health Care Information for all, including the
blind

Date:               January 17, 2013

________________________________________________________________________

THE PROBLEM

In 2011, the Maryland General Assembly established the Maryland Health
Benefits Exchange to ensure that all of its citizens would have access to
health care. The Maryland Health Benefits Exchange is creating a new web
site, marylandhealthconnection.gov, for individuals, families, and small
businesses to learn about their insurance options, compare different plans,
and enroll for health coverage. This web site will become operational in
October 2013. Will the information be accessible to blind citizens of
Maryland?

PROPOSED ACTION

During the 2013 session, the Maryland General Assembly will determine how to
fund the functions of the Maryland Health Benefits Exchange after federal
money runs out in 2014. When considering funding for the Exchange, the
Maryland General Assembly should designate specific funds to ensure
nonvisual access to marylandhealthconnection.gov. The dynamic nature of this
web site, with its recurring updates, will require continual monitoring for
nonvisual access. Therefore, continued funding to review and implement
nonvisual access must be included in planning for the future funding
requirements for the Maryland Health Benefits Exchange.

BACKGROUND

The Affordable Care Act was signed into law by President Obama in 2010. The
purpose of this legislation is to assure that all Americans have access to
affordable health insurance. When the Affordable Care Act is fully
implemented in 2014, all Americans will be required to have health insurance
through their employer, through a public program such as Medicaid or
Medicare, or by purchasing coverage from a state-based health insurance
exchange.

Maryland has taken a leading role in health care reform and was one of the
first states to establish a health benefits exchange. Maryland is developing
a one-stop shopping web site to enable insurance customers to select and
enroll in the insurance program that best meets their needs. This direct and
less complicated approach is intended to ensure access to affordable health
insurance, continuity of care, and seamless transitions for individuals and
small businesses.

If the Maryland Health Benefits Exchange designs its web site with
accessibility in mind, that web site will be usable by blind persons.
Through specialized screen magnification or synthetic speech screen reading
software, blind persons will be able to read information, fill out forms,
and purchase insurance from this web site. Although nonvisual access
techniques are widely known and easy to implement during the design phase of
web site development, these techniques are too often ignored or overlooked.

MARYLAND HAS A POOR RECORD ON ACCESSIBILITY

The executive branch of Maryland State government discriminates against
blind citizens by denying access to public information and services.
Maryland has failed to provide consistent nonvisual access to its web sites
and online courses. This discrimination persists even though there are
specific state and federal laws requiring access for all citizens. These
laws have been in effect for decades.

The excerpts from A Longitudinal Study of State Government Home Page
Accessibility in Maryland and the Role of Web Page Templates for Improving
Accessibility by Dr. Jonathan Lazar, Dr. Brian Wentz, and Towson University
students (see the appendix, page 4) demonstrates Maryland's long-standing
and persistent failure in nonvisual access. The most egregious case in the
study was the Injured Workers Insurance Fund web site. The sign-in link was
a graphic without an alternate accessible text link. Therefore, blind users
would be unable to log in to the web site, file claims, pay bills, or print
certificates of insurance.

Of the twenty-five Maryland state government home pages evaluated by the
study in 2012, twenty-three had accessibility violations. One of the most
prominent violations, exhibited by fifteen of these web sites, is the
failure to include a text description of a graphic or picture, which means
that a blind user does not know what is being communicated. Another example
is that twelve of the twenty-five pages evaluated had forms that were not
accessible or were not properly labeled, which means that blind users would
not be able to participate in the services that these websites offer.

The Longitudinal Study also suggests remedies to solve many of the problems
of these state government home pages. Accessibility can be achieved if
Maryland state government will commit seriously to the implementation of
nonvisual features.

MARYLANDHEALTHCONNECTION.GOV OFFERS A NEW BEGINNING

The time has come to make a change in how Maryland addresses accessibility
of its government web sites. Providing funding for accessibility of the
Health Benefits Exchange web site offers an opportunity to reverse the
unfortunate trend in Maryland state government outlined in the Lazar-Wentz
Longitudinal study. Accessibility will not become a reality unless specific
funding is provided for it.

BENEFITS OF THE PROPOSED RECCOMMENDATION

*	When nonvisual access features are incorporated into a web site,
blind users can read the information, navigate the web site, and fill out
necessary forms. These features are beneficial not only to the blind, but
will make the web site easier for all citizens to use.
*	Allocating specific funding will decrease the number of violations.
The Maryland Health Benefits Exchange must complete a monumental task in a
short period of time. Funding for accessibility will give this issue the
prominence and attention that it deserves.
*	Designing an accessible web site does not have to be expensive. It
is difficult to define a specific price for accessibility because the nature
and size of web sites vary. What is certain is that it is less expensive to
achieve accessibility if it is incorporated during the design phase of web
site development. A good rule of thumb is that accessibility will add
approximately 2% to the cost of the web site.

CONCLUSION

The executive and legislative branches of Maryland state government are
committed to providing affordable health care for all citizens. Maryland has
been a leader in establishing a health benefits exchange to make sure that
everyone has health care insurance. Blind persons deserve the same
opportunities to obtain information about health care insurance as our
sighted peers.

Maryland state government has a poor record of providing web site
accessibility to blind and print disabled citizens. Providing the Maryland
Health Benefits Exchange with specific funding for accessibility presents
Maryland state government with an opportunity to demonstrate leadership in
inclusiveness. If the Maryland General Assembly is serious about making sure
that all citizens have access to health care, it should demonstrate its
commitment by allocating specific funding to achieve this goal.

APPENDIX

Excerpts From 

A Longitudinal Study of State Government Home Page Accessibility in Maryland

and the Role of Web Page Templates for Improving Accessibility

Dr. Jonathan Lazar, 

Radcliffe Institute for Advanced Study, Harvard University and 

Department of Computer and Information Sciences, Towson University

Dr. Brian Wentz (corresponding author)

Department of Computer Science and Information Technologies

Frostburg State University

Abdulelah Almalhem, Alexander Catinella, Catalin Antonescu, Yeveniy
Aynbinder, Michael Bands, Edward Bastress, Brandon Chan, Brian Chelden,
Darin Feustel, Nabin Gautam, Whitney Gregg, Michael Heppding, Cory
Householder, Alex Libby ,Corey Melton, Jack Olgren, Loren Palestino, Morgan
Ricks, Scott Rinebold, Matthew Seidel (all students from Towson University)

Abstract

It is well documented that government, at all levels, continues to have
problems ensuring that government web sites follow laws related to web
accessibility for people with disabilities. Although there are a number of
published studies on government web accessibility that are point-in-time,
there are no published studies consisting of a longitudinal analysis of
state-level government web site accessibility. This paper contributes to the
research literature in three ways: 1) an accessibility inspection of 25
Maryland state government home pages in 2012 which involved 150 human
inspections of web pages, 2) a comparison of the results from 2012 to a
similar accessibility evaluation in 2009, and 3) a discussion of the role of
a web page template, which was introduced in Maryland state government
shortly after the 2009 evaluation. The data from this longitudinal
evaluation leads to the conclusion that web page templates do tend to result
in more accessible sites within state government.

Results

Accessibility violations

Most of the Maryland State government home pages evaluated contained one or
more violations of the Section 508 guidelines, with the exception of the
Maryland Department of Rehabilitation Services and the Library for the Blind
and Physically Handicapped. Table 4, see page 3, contains a matrix of the
paragraphs with violations by each site. There were violations in paragraphs
A, B, C, D, F, L, M, N, and O. Paragraph A (lack of text equivalent for
graphical elements) was the most violated paragraph (15 out of 25 web
sites), with M (linked plug-in or applet), N (properly labeled forms), and O
(lack of method to skip repetitive navigational links) following closely
behind. Examples of violations in paragraph A included an "eServices"
sign-in link on the Injured Worker's Insurance Fund web site which was a
graphic without alternate text. Without an accessible link, this could
prevent users who are blind from being able to log in and report claims, pay
bills, and print certificates of insurance. Paragraph B (violated on five of
the web sites) requires synchronized alternatives for multimedia, such as
audio and video clips on web sites. Paragraph C (information with color
should be available without color) was violated on the Maryland Tax Court
and Governor's Office for Minority Affairs web sites. The Maryland Lottery
had violations in paragraph D (page unusable without the style sheet
enabled). The Office of Minority affairs violated paragraph F because it had
a client-side image map that was not accessible via keyboard. Paragraph L
requires that content and functionality provided by scripting languages is
also available to users of assistive technology or in some equivalent form
on the page. Four of the web sites evaluated violated this guideline, and an
example of this is illustrated by the Maryland Environmental Service web
site, which has a drop-down menu for navigation which is inaccessible to
keyboard-only users. When web page content requires a plug-in or applet,
paragraph M of Section 508 requires that a link to an accessible version of
that plug-in be provided (such as an Adobe Acrobat reader or Microsoft Word
reader). Paragraph N requires that all online forms be accessible and
properly labeled, and this guideline was violated by 12 of the 25 home pages
evaluated. Paragraph O requires a method for users to skip repetitive
navigational links, specifically in the form of a link to skip to content.

Section 508

Paragraph:

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Assessments/Taxation

X

Children

X

X

Dept of Aging

X

Dept of Disabilities

X

DORS

Emergency Mgmt

X

X

X

X

Enviro. Service

X

X

X

X

X

Governor's Grants

X

X

Housing and Community Dev.

X

X

X

X

Injured Workers Ins.

X

X

X

X

Library for Blind and PH

Lottery

X

X

X

X

X

Lt. Governor

X

X

X

Minority Affairs

X

X

X

X

X

X

MTA-Mobility

X

X

X

MVA

X

People's Counsel

X

X

X

X

Public Defender

X

X

Public School Construction

X

X

X

Retirement and Pension

X

X

X

Rural MD Council

X

X

X

Service/Volunteerism

X

Supplemental Retirement Plan

X

X

X

X

Tax Court

X

X

X

Treasurer

X

X

Table 4. Matrix of Section 508 Paragraphs Violated by Each Home Page

Conclusion

Web accessibility among Maryland state agency home pages continues to be a
problem, despite clear laws in effect since 2005. It is likely that other
state government web pages have accessibility problems, and it is
well-documented that federal web pages continue to have accessibility
problems. Among the 15 sites evaluated in both 2009 and 2012, there were
slight improvements in accessibility. Furthermore, the impact of the new
state web page template was remarkable. For home pages that clearly utilized
the state web page template, there were much higher levels of accessibility,
and a greater likelihood that a web accessibility statement was present. The
existing template has minor flaws related to accessibility, and it is likely
that if the web page template was re-designed to include improved
accessibility, it would result in even further improvement for a number of
Maryland state agency web sites. The use of a web page template seems to
result in improved web accessibility in the state of Maryland. We therefore
offer three policy recommendations. First, develop web page templates, and
ensure that those templates are fully accessible. Second, require use of web
page templates when web sites are re-designed. Lastly, require that ongoing
compliance activities take place, and that accessibility efforts are clearly
posted.