If America is truly committed to human rights and equality of opportunity, it will direct greater effort toward helping the disabled. (The opinions expressed in this article are those of the individual author, whose information can be found below.)
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:
Important Statistics and Facts:
Four-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 providing 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. 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 (From Our Student Economist Team):
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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