What Will the Trump Administration Mean for People With Disabilities?

As a disabled person, I am terrified of the Trump administration.

When I say that, people tend to assume that it’s because our president-elect famously mocked a disabled journalist at a rally (and, implausibly, continues to deny what we all saw happen). But that moment isn’t what keeps me up at night. What renders me sleepless is the fear of his proposed policies: repealing the Affordable Care Act; shuttering the Department of Education; appointing a Cabinet with no regard for civil rights, safety nets, or inclusion, to be overseen by a vice president who gutted Medicaid in his state and a speaker of the House who wants to gut Medicare.

Over eight years, the Obama administration pursued profoundly progressive policies for disabled Americans. In dozens of ways big and small, the administration has pushed for greater inclusion of people with disabilities in the community And now, as Inauguration Day looms, I fear that hard-won progress will be rolled back.

Right now, the airwaves are full of folks telling us to take everything with many grains of salt, to wait and see. But it’s hard to be calm. Our president-elect has selected a congressman to run Health and Human Services who has repeatedly told us exactly how he would dismantle the Affordable Care Act. His pick for the Centers for Medicare & Medicaid Services believes that poor Americans don’t have enough “skin in the game” when it comes to their health. His choice to helm the Department of Education is a strong proponent of charter schools, which are disastrous for students with disabilities, students of color, low-income students, and students in her own state. (At her confirmation hearing Tuesday, nominee Betsy DeVos seemed completely unfamiliar with the federal Individuals With Disabilities Education Act and said initially that accommodating students with disabilities should be left up to states.) His vice president has an alarming track record on civil rights, while his proposed attorney general once referred to disabled students as the “single most irritating problem” facing teachers today.

Naturally, at the top of the nightmare list is a repeal of the Affordable Care Act. The ACA is arguably second only to the Americans With Disabilities Act when it comes to game-changing disability rights law. No insurers would meaningfully cover us, so many disabled Americans historically had to live in poverty in order to qualify for Medicaid. By banning discrimination against people with pre-existing conditions, the ACA made it possible for millions of Americans with disabilities to enroll in commercial insurance, afford needed medical care, move, and change jobs. I can vividly remember a health insurance broker sitting in our kitchen with my parents when I was a teenager and urging them to kick me off our insurance and put me on Medicaid (and into a life of enforced poverty) as soon as possible, to bring our premiums down and take the burden off my father’s small business. They didn’t, and under the ACA, that nightmare was relegated to the past where it belongs—unless, of course, Trump brings it back.

It’s unclear just how much the president-elect actually knows about the ACA, particularly given his comments on the importance of coverage for pre-existing conditions and allowing young people to remain on their parents’ insurance in the days following the election. But even if coverage for people with pre-existing conditions is maintained, the ACA is an intricate ecosystem, with deep reaches into other sectors of health care. We could see important nondiscrimination policies evaporate, such as the prohibition on medical underwriting, which permitted insurers to charge higher premiums depending on a consumer’s age, gender, occupation, health history, and virtually anything else. Also at risk are rules aimed at eliminating health disparities in marginalized communities, as well as components such as the Community First Choice option, which allowed people with disabilities living in nursing homes to receive services in our own homes instead. Even simply lifting the individual mandate could be enough to make the whole system collapse, and for disabled people, that kind of thing can mean life or death.

And then there’s the talk about block-granting Medicaid. Medicaid provides health insurance to poor people (and people with disabilities are disproportionately likely to be poor) as well as basic services for people with significant disabilities, through a combination of state and federal funds. A block grant, which caps federal Medicaid dollars rather than matching a given state’s own needs and budget, would slash federal funds, shifting responsibility for Medicaid almost entirely to the states. Despite popular Republican rhetoric, block grants would actually decrease state flexibility, drastically reducing their ability to provide coverage, experiment with new service models, or pursue any sort of “innovation” beyond slashing enrollment. The reality is that our states need more Medicaid dollars, not less—states are still often unable to cover everyone in need, and waiting lists for disability services such as medical transportation or personal attendant services can take more than a decade to clear.

In addition to its strong commitment to keeping people with disabilities alive, the Obama administration has done unprecedented work to advance our civil rights, particularly through the Department of Justice. For the past eight years, the Department of Justice has advanced the right of people with disabilities to live in our communities, attend our neighborhood schools, and earn fair wages for our labor. In a major development, the DOJ also clarified that the Americans With Disabilities Act applies to people with disabilities in the criminal justice system, including in the contexts of policing, prison, and re-entry into society after incarceration—badly needed guidance, given that more than 50 percent of the victims of police violence are people with disabilities, particularly disabled people of color.

Similarly, the Department of Education has spent the past eight years leading on issues of critical importance to students with disabilities. It funded significant work to increase the inclusion of students with disabilities in the general education classroom and promote high expectations and bright futures. But beyond that, the department has issued badly needed guidance on the right of nonspeaking students to effective communication supports; emphasized the need to ensure that students on the autism spectrum are receiving a range of appropriate and individualized supports; and urged schools to move away from restraint, seclusion, corporal punishment, and other forms of discipline that disproportionately target students with disabilities (particularly disabled students of color). In 2014, the department clarified that bullying can be considered a violation of a student’s civil rights, including the right to a free and appropriate education in the least restrictive environment.

Courtesy of Slate

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