Big Picture

The United States has many laws protecting Americans with disabilities. Yet, many societal problems for disabled populations persist, including a lack of educational opportunities and discriminatory attitudes from employers. Change will require comprehensive cooperation and support from community, societal, local, state and federal agencies.

Operative Definitions

• Disabilities: An overarching term which includes physical impairments, mental limitations and restrictive health conditions.
• Americans with Disabilities Act (ADA): According to the official website of the Americans with Disabilities Act (2017), this is “a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public.” 
• Socioeconomic Status (SES): A multifaceted state of being, which includes educational attainment, financial security and social status.
• Social Determinants of Health (SDOH): Conditions in the environment in which people live, learn, and work that have a major effect on their health, functioning, and quality of life outcomes and risks. 
• Substance Use Disorder (SUD): A mental disorder that affects a person’s ability to control their usage of illegal or illicit substances, like drugs, alcohol or certain medications. Opioid Use Disorder (OUD) is considered a Substance Use Disorder. People with addictions are protected by the ADA, except for when individuals with addictions are actively engaged in “illegal use of drugs,” specifically when they take adverse action on the basis of their current use. They are not, however, denied access to emergency or rehabilitation treatment for their substance use. 
• Healthy People 2030: A federal goal to set data-driven objectives to improve American health and well-being over the next decade. The objectives were developed by a number of workgroups made up of subject-matter experts with different backgrounds. 

Important Statistics and Facts

• As of 2020, there are an estimated 61 million people living with at least one disability in the United States.
• An estimated one-third of all American households have at least one person with one or more disabilities. 
• Disability-associated healthcare costs made up about 36 percent of healthcare expenses during 2015, totaling $868 billion nationwide, according to the CDC. 
• The CDC found that personal care assistants cost over $30,000 annually, which is about 75 percent of the annual income of individuals over the age of 65. 
• According to SAMSA, people with physical and cognitive disabilities have higher prevalence of serious mental illness (SMI) and substance use disorder (SUD). People with disabilities who have experienced a serious traumatic injury could be at greater risk of opioid misuse and potentially at greater risk of death from opioid poisoning, as described by the National Institutes for Disability, Independent Living, and Rehabilitation Research (NIDILRR). 
• The Kaiser Family Foundation (KFF) found that as of 2022, 39 states have adopted and implemented Medicaid Expansion, while the remaining 12 have yet to do so.
• In 2016, the cities that experienced the greatest gains in local health all used methods of  ‘pooling’ community resources from a diverse array of organizations, including hospitals, businesses, government agencies and so on. Partnerships between public and private organizations on the local level are one of the best ways to increase local health. 

4-Point Plan

1. Appoint community health overseers to create community-based frameworks that help people living with disabilities access care. Many individuals with disabilities have a low socioeconomic status and can’t afford adequate care, being at a greater risk for poverty, unemployment, poor education and susceptibility to more disabilities, such as diabetes, obesity and depression. As noted earlier, local initiatives designed to pool community resources into improving community health have proven to be especially effective. To motivate more of these local efforts and ensure that they’re adequately overseen, city and/or county governments should appoint a community health overseer tasked with mediating partnerships between local organizations, including hospitals, hospices, churches or other religious organizations, tribal organizations, state institutions, businesses and so on. To ensure that the community health overseer is appointed, state governments or the federal government could require cities and/or counties to appoint someone to the role. The precise activities of the community health overseer will depend on the characteristics and resources of the corresponding community. However, having an executive official directly tasked with overseeing the pooling of local resources into community health initiatives will act as a catalyst for creating community-based frameworks for helping people with disabilities, and people more broadly, access care.
2. Strengthen disaster resilient infrastructure. People with disabilities are more vulnerable to emergencies and disasters. Strengthening disaster and emergency preparedness is one way to improve the systems in place to help people with disabilities. These improvements must be made inclusive for disabled individuals, with demonstrable protections in place for such vulnerable groups. See our proposal, “Building a Disaster Resilient Infrastructure,” for more information on how this can be accomplished.
3. Vote to expand Medicaid services and the Healthcare Marketplace created under the Affordable Care Act (ACA) to include adequate coverage plans for disabled people. Medicaid is an important program that provides free to low-cost healthcare coverage to groups in the U.S. at higher risk for illness, disability, or poverty. The Affordable Care Act proposed expanding Medicaid coverage, such that households with incomes at or below 33 percent of the poverty line would qualify. It’s important to note that this expansion would increase Medicaid accessibility for populations more prone to disability and illness, as individuals living with disabilities tend to be of lower socioeconomic status than other groups. (This is illustrated by the fact that, especially in states which have adopted the Medicaid expansion, disabled individuals are often dually eligible for coverage, in that they qualify due to disabilities and socioeconomic status or other factors.) Most states, including predominantly Republican ones, have adopted this expansion, making it a relatively bipartisan policy. The expansion has not been adopted by Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Wisconsin or Wyoming. These states should adopt the Medicaid expansion by 2025. The Affordable Care Act healthcare marketplace should also be reevaluated annually to determine whether healthcare plans can be made more suitable for disabled individuals, who often cannot meet deductible and copay costs—due to higher levels of poverty—but who also require greater support from healthcare services.
4. Use the Social Determinants of Health (SDOHs) as a framework for legislation. Social determinants of health include housing, food and nutrition, transportation, social and economic mobility, education and environmental conditions. Often, policies aimed at helping disabled individuals focus exclusively on addressing medical issues directly, generally through more healthcare funding. Legislatures need to explicitly address the social determinants of health in their disability policies. The federal government can attribute a portion of Medicaid funding to states as a demonstration of how the social determinants of health are addressed in state-level policies. To qualify states for Medicaid funding, these policies should be specific, measureable, achievable, relevant and time-bound, or SMART. Such policies may include improving adequate housing access via the development of more low-income housing or using government contractors to increase food security. These improvements would promote the health of the entire population but would be especially impactful for the disabled. Alongside state-level policies aimed at addressing the social determinants of health, the Department of Health and Human Services should remain focused on achieving its Healthy People 2030 objective. 

Why This Initiative is Important

The health of U.S. disabled populations requires a multifaceted approach, addressing the financial, social, physical and governmental needs of those living with disabilities. Community based initiatives are important for addressing the locally specific needs of disabled populations and giving these initiatives greater executive direction at the local level will motivate their implementation. Measures to improve infrastructure in a way that’s cognizant of the needs of disabled people are also important, as those living with disabilities are more vulnerable to public health emergencies, from natural disasters to events like the COVID-19 pandemic. Reducing the costs of healthcare coverage for disabled people is also crucial, as those with disabilities tend to be of lower socioeconomic status. Further, the social determinants of health must be considered in any response to the hardships faced by disabled populations. Using these measures, the United States can improve the health of disabled people and, by extension, the rest of the country. 

Economic Impact

1. According to data from the Centers for Disease Control and Prevention (2021), “In 2015, disability-associated healthcare expenditures accounted for 36% of all healthcare expenditures for adults residing in the United States, totaling $868 billion.” Any increase in funding may decrease the disability related healthcare expenditures faced by the federal government in the future. Researchers have previously found clinically equivalent treatments at a lower cost and the same can be done for Medicare with increased research funding. 

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