WASHINGTON ― People with disabilities and their family members are deeply afraid of what a Donald Trump presidency has in store for them ― and they are already gearing up to resist harmful policy changes.
First and foremost, advocates worry that Trump’s professed desire to weaken the country’s safety net could jeopardize the lives of vulnerable Americans. They’re also concerned that federal agencies’ roles in policing discrimination and driving reforms of law enforcement practices will change.
Although it is impossible to know how Trump will govern, his campaign platform, the Republican Party’s priorities and his bullying personality ― embodied by his campaign-trail mockery of a reporter with the joint condition arthrogryposis ― are not reassuring, according to disability rights activists.
“It’s a disaster,” said Ari Ne’eman, president of the Autistic Self Advocacy Network, which is run entirely by people on the autism spectrum. “Obviously, with somebody like Trump, you never really know what he is going to do, but assuming we can take him at his word on his stated policy positions, there is tremendous, tremendous risk for people with disabilities.”
The Trump campaign did not respond to The Huffington Post’s request for comment on disability rights advocates’ concerns. Below are some of the things they’re worried about.
Republicans would have to overcome Senate Democrats’ power to filibuster, however, which they may be able to do through budget reconciliation.
Eliminating the signature reform could negatively affect people with disabilities in at least two major ways. It would presumably undo regulations that preclude insurance companies from refusing to cover people with pre-existing conditions ― a description that fits many people with a physical, psychological or developmental disabilities.
Republicans might scramble to retain that provision of Obamacare due to its popularity, but its financial viability would be severely limited without other clauses, like the individual mandate that balances out high coverage costs for sicker people with the lower costs for new, healthier insurance customers.
“If you could do the popular parts without the unpopular parts, people would already have done it,” said Harold Pollack, a professor at the University of Chicago who specializes in disability and health care policies.
As a result, Pollack estimated, whatever protections manage to survive Trump would likely be as porous and inadequate as what existed before Obamacare.
“Assuming we can take him at his word on his stated policy positions, there is tremendous, tremendous risk for people with disabilities.”
Indeed, since the election, Trump has said he would like to keep popular aspects of the law, like the protections for people with pre-existing conditions.
But he did not indicate he is interested in preserving the law’s expansion of Medicaid.
Rolling back the health care law’s expansion of Medicaid would hit Americans with disabilities especially hard. Some 10 million Americans insured by Medicaid are people with disabilities, comprising 15 percent of all enrollees. And critically, Medicaid pays for most disability services, like home health aides ― not just traditional health care.
The Center on Budget & Policy Priorities, a liberal think tank, estimated that the Republican-led House Budget Committee’s 2015 budget repealing Medicaid expansion would strip at least 14 million Americans of their health insurance.
Trump’s proposals to replace Obamacare are a mix of recycled conservative ideas that come nowhere near adequately substituting the coverage provided by the law’s expansion of Medicaid. One of Trump’s main recommendations ― allowing everyone to deduct health care premiums from their taxes ― would not help low-income people with disabilities who need Medicaid, since their tax burdens are typically much lower than their insurance costs.
Trump’s campaign platform calls for turning Medicaid into a “block grant” ― or flat annual funding amount ― for states to insure poor residents with looser requirements for determining who is eligible and the services they provide. Currently, Medicaid functions as a flexible needs-based insurance program designed to provide health care coverage to as many impoverished people as necessary.
It is unclear how Trump would structure his block-granting plan, but virtually all existing proposals for doing so would dramatically reduce present funding levels, resulting in far lower coverage rates. The Urban Institute projected that a 2012 Republican House Budget Committee block-granting plan would, over a 10-year period, prompt states to insure 14.3 million to 20.5 million fewer people than they would have under current law.
“I’m sure he’ll say it is ‘the best Medicaid cut, a beautiful Medicaid cut,' no doubt.”
Taken together, the losses in coverage from block-granting and repealing Obamacare’s Medicaid expansion ― to say nothing of the effect of disbanding the Obamacare exchange and eliminating the subsidies for its participants ― could easily cause 30 million Americans to lose health insurance, a significant number of whom are people with disabilities.
“I’m sure he’ll say it is ‘the best Medicaid cut, a beautiful Medicaid cut,’ no doubt,” Pollack said. “But there is a real possibility he will cut services to vulnerable populations, and there are many Republicans in Congress who want to do that.”
For Americans with disabilities who rely on Medicaid, finding coverage elsewhere is often not an option.
“I have many friends who depend on Medicaid for home care. Their lives are at risk if we block-grant Medicaid,” Ne’eman, of the Autistic Self-Advocacy Network, said.
Reducing ADA Enforcement And Police Accountability
The president conducts a significant amount of disability policy through control of various regulatory agencies. The Department of Justice’s civil rights division, for example, pursues complaints against employers, businesses and other institutions for violating the Americans with Disabilities Act, the 1990 law barring discrimination against Americans with disabilities.
The next administration could cut back on the civil rights division’s resources or change its priorities, says Allison Wohl, executive director of the Association of People Supporting Employment First, a disability rights group.
“If that is whittled down, it will undermine ADA enforcement ability,” Wohl said.
And Wohl is skeptical Trump’s political appointees to agencies like the Centers for Medicare & Medicaid Services and Department of Labor would be committed to ensuring access to benefits and suitable workplace accommodations for people with disabilities.
“The DOJ’s pursuit of police accountability is a disability rights issue as well.”
A Trump DOJ could also stall or reverse progress on police accountability ― to the detriment of people with disabilities ― says David Perry, a leading writer on disability issues whose son has Down syndrome.
As many as half of all people killed by police are disabled, according to Perry’s original research for the Ruderman Family Foundation ― including Eric Garner, who suffered from asthma and heart disease, he points out.
“His last words are ‘I can’t breathe.’ That is a statement to a government employee that he requires reasonable accommodation, which they are required to provide under the Americans with Disabilities Act,” Perry said.
That means the DOJ’s pursuit of police accountability is a disability rights issue as well.
“DOJ is working with police departments on consent decrees to reform policing,” he said. “I am not convinced that [Rudy] Giuliani’s Department of Justice [would continue] those efforts.”
Likewise, Perry wonders whether Trump’s Department of Education will take a stern line with states that fail to honor their obligations to accommodate students with disabilities in their public schools.
“Budget-strapped states are already cutting back on special education and pushing back on eligibility, including Texas and Connecticut. We need a Department of Education to control this and stop this,” Perry said.
The Best-Case Scenario
Protecting people with disabilities from discrimination has traditionally been a bipartisan cause in Congress. Members of both parties voted to enact the ADA under Republican President George H.W. Bush, and they united again in 2014 to pass legislation incentivizing greater workplace training and employment opportunities for people with disabilities.
Wohl, of the Association of People Supporting Employment First, is confident that congressional Republicans will continue to support these kinds of measures going forward.
“There are a number of Republicans in the House with children and grandchildren with disabilities,” Wohl said, citing Reps. Cathy McMorris Rodgers (R-Wash.), Gregg Harper (R-Miss.), Pete Sessions (R-Texas) and Pat Tiberi (R-Ohio). “They have been real champions of our work.”
Continuing traditionally bipartisan workplace integration initiatives would be a “best-case scenario,” Perry said, but one that would likely fail to assist the people with disabilities “most at risk for violence and trauma,” including people who are poor, live in marginalized communities of color or identify as LGBTQ and disabled, according to Perry.
One way or another, President-elect Trump has a long way to go to regain the trust of disability rights advocates, Perry said.
Trump not only mocked New York Times reporter Serge Kovaleski on the campaign trail last November ― he also falsely claimed that vaccines cause autism two months prior to that. And he has faced at least eight lawsuits for failing to provide reasonable accommodations for people with disabilities in his real estate properties.
“Trump is the most ableist president in modern history,” Perry concluded. “He takes any kind of physical or mental difference that he perceives or imagines as a weakness and uses it as a tool for dominance.”
This story has been updated to reflect Donald Trump’s recent remarks suggesting he would keep aspects of the Affordable Care Act.