Don’t Underestimate the Catastrophic Impact That the Trump Administration’s Policies Will Have on People With Disabilities

On Tuesday, Republican Rep. Tom Price of Georgia, Trump’s nominee for secretary of the Department of Health and Human Services, is scheduled to testify before the Senate Finance Committee. During his confirmation hearing, he will almost certainly be grilled about the radical changes to our health care infrastructure that he and Trump intend to implement, but senators should make it a point to dig deep into how the administration’s proposals will endanger the lives of people with disabilities.

We already know that Price supports repeal of the Affordable Care Act, a law that includes numerous protections for people with disabilities. For example, the ACA ensures insurance coverage for people with pre-existing conditions — such as people with disabilities — and makes certain that individuals with disabilities are not priced out of coverage or denied health care after pricey hospital stays.

What many people don’t yet know is that Price, House Speaker Paul Ryan, and Trump have proposed making significant changes to Medicaid, the health insurance program that covers low-income people, including those with disabilities. These changes are not to make the program more efficient. Medicaid is significantly more efficient than private insurance; these changes are to finance tax cuts. The plan is to slowly reduce the dollars available, so that at the end of ten years, $1 trillion will have been cut from healthcare for poor people and people with disabilities. 

Not surprisingly,  these cuts would be devastating.  What is more, the changes in how the system is run would  risk the fundamental right to freedom for people with significant disabilities.

The Trump administration has a long road to walk before it can repair its damaged reputation within the disability community. 

Medicaid is the primary source of funding for the services that allow people with disabilities to live in their own homes and make their own choices about daily life, instead of being warehoused in institutions. Medicaid allows people who would otherwise languish in nursing homes and psychiatric hospitals to move to a community where they can work, play, and live, integrated with the rest of the society. 

Elizabeth Grigsby, who has cerebral palsy, can tell you what it was like to live in an institution. She was in a board and care home for six months that was run like a nursing home. “Someone else decided when I would get up in the morning,” she said, “what I would have for breakfast, if I got to go outside that day, whether I could apply for a job, what and when I would eat dinner, and what I got to watch on television at the end of the day.” 

Ms. Grigsby now works three days a week as a consumer advocate with the Golden Gate Regional Center. “With services and supports, I am in control of my own life,” she said.  “I direct my attendant as to what I will eat, where I will go, and what job I hold. That is autonomy. An institution is no better than a prison.” 

In other words, Medicaid is the program that makes real the right that individuals have, under the Americans with Disabilities Act, to freedom.  Medicaid is the program that makes real the right that individuals have under the ADA to integration – instead of segregation in institutions.  And these rights were recognized and affirmed in 1999 by the Supreme Court in Olmstead v LC, one of the most important civil rights decisions for people with disabilities in our country’s history.

But Price and many other members of Congress want to turn back the clock and undo all of our hard-fought gains. They seek a radical restructuring of Medicaid that will allow them to significantly cut funding to the program. They propose turning the program into a “block grant” or by instituting a “per capita cap,” meaning that states would receive a fixed amount of dollars, and the federal government would no longer provide oversight or incentives. The federal oversight and incentive programs are what have reformed state systems to move from institutional care to community-based services. The result would be dangerously reduced benefits that support the autonomy of people with disabilities.  

Every senator who will question Rep. Price at Tuesday’s confirmation hearing must fully explore his views and the administration’s plans to upend the Medicaid program. And they must make clear their opposition to any change in Medicaid’s financing that will degrade the health, welfare, and autonomy of people with disabilities.

The Trump administration has a long road to walk before it can repair its damaged reputation within the disability community. Supporting dangerous and ableist public policies that undermine Medicaid and threaten the civil rights of people with disabilities is a sharp move in the wrong direction.

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