By September 30, the U.S. Senate must pass its latest attempt to end the Affordable Care Act (ACA) as we know it. If the Graham-Cassidy bill succeeds, it will punctuate the end of a long and bitter fight that started with the ACA in 2009. It would also dispel any notion in federal politics that disability is a nonpartisan issue.
Without a full Congressional Budget Office score of the latest version, it’s hard to quantify this particular bill’s potential impact on access to health care in the United States. But it’s safe to say, on the basis of prior estimates, that it would be particularly hard on vulnerable populations. Disabled people in particular may bear the brunt of the service cuts, making this very much a disability rights matter—a fact many mainstream organizers and media outlets have overlooked. And that’s deeply unfortunate, because when it comes to disability, Congress has been remarkably good at leaving party ideology at the door in the interest of the common good.
The crown jewel of disability legislation in the United States is the Americans With Disabilities Act (ADA) of 1990, authored by Iowa Democrat Tom Harkin but signed into law by Republican President George H.W. Bush, in a bipartisan moment in keeping with the record on disability. This is not to say it was all a bipartisan stroll through the Rose Garden. It took years of collaborative effort between Congress and the White House, along with outside pressure from disability rights activists, to pass the ADA, which builds on the Rehabilitation Act of 1973—also introduced by a Democrat and signed into law by a Republican president—to crystallize civil rights for disabled people. Still, right alongside Harkin, Republicans like Bob Dole (KS) and Orrin Hatch (UT) championed the legislation, which passed the Senate by a vote of 76 to 8. And 25 years later, Dole was asking Congress to ratify the Convention on the Rights of Persons with Disabilities.
Other historic disability-related legislation has also been relatively uncontroversial. Critical updates to the Individuals with Disabilities Education Act (IDEA) introduced by Delaware Republican Michael Castle in 2003, passed the Senate 95 to 3, for example. The ABLE Act of 2014, which expanded financial autonomy for disabled people, was bipartisan and passed by a large margin. The same was true of the Help America Vote Act of 2002, which included key provisions for disabled voters; the Genetic Information Nondiscrimination Act of 2008; and the Mental Health Parity Act of 1996.
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Twenty-seven years after the ADA, though, there are cracks in the facade. Many public accommodations remain inaccessible, and congressional Republicans—led, of course, by President Donald Trump—are making open war on the disability community. The high-profile fight over health care, dramatically illustrated by activism from ADAPT, is just part of the story, but it’s a stark starting point to exemplify the change in Republican attitudes.
Under Graham-Cassidy, the United States would see Medicaid funded through block grants with enrollee caps, which have been heavily criticized for their harmful effect on recipients. The bill eliminates funding for Medicaid expansion (while adding sweeteners for some states), further cuts Medicaid eligibility, allows insurers to discriminate against people with preexisting conditions, abolishes the individual mandate, and does away with the ten essential benefits. Naturally, it strips funding from Planned Parenthood for a period of one year. As of last week, Kaiser Family Foundation found the bill also effectively punishes Medicaid expansion states, which stand to lose $180 billion in federal funding. With this bill, Republicans are targeting nearly everyone in the United States—disabled people included.
Beyond Obamacare repeal, Republicans’ broken promises on Medicare, Social Security, and Social Security Disability Insurance (SSDI) are another piece of the story—because while Donald Trump once said, “There will be no cuts to Social Security, Medicare and Medicaid,” his party has no such compunctions. On top of slashing Medicaid funding and eliminating the ACA, the 2017 House budget proposal includes cuts to SSDI and suggestions for reframing Medicare that would functionally change how it works.
Entitlement programs, especially Medicare and Social Security, have long been treated as the third rail of U.S. politics: too dangerous to touch without infuriating the electorate. But Republicans have grabbed that rail with both hands, demonstrating an apparent willingness to throw almost 50 million seniors and 57 million disabled people under the bus.
Meanwhile, ever since 2015, House Republicans have introduced and reintroduced the ADA Education and Reform Act, which would radically change the way the Americans with Disabilities Act is enforced, effectively putting a heavy burden on disabled people to enforce their own civil rights. The act has died in committee every year—except for this one. Earlier this month, it passed muster at the House Committee on the Judiciary and was sent to the floor, though it hasn’t been scheduled for debate as of press time.
While Skopos Labs, a nonpartisan firm that uses machine learning to make strategic forecasts, estimates the chance of passage is still relatively low, the fact that the bill has progressed further than ever before signals an important sea change in federal politics. A sensationalized documentary on CBS in December 2016 may have fed the flames. It focused on largely mythological “drive-by” ADA lawsuits: ADA opponents claim unscrupulous lawyers team up with disabled people to slap businesses with lawsuits for even minor ADA infractions. In truth, efforts to enforce the ADA are far more complicated. One option for requesting action on ADA violations is contacting the U.S. Department of Justice. If that doesn’t work, disabled people are forced to resort to lawsuits themselves, and victory does not come with monetary damages.
Overall, congressional disability politics are starting to more closely mimic the dynamic in some states, where disability has been used as a partisan wedge for decades. Leveraging disability in state anti-choice legislation is a classic example, but the issue has also played a prominent role in funding battles in states like California and Connecticut, just as states have explored legislation aiming to curb ADA suits.
While members of the disability community are politically diverse and represent a wide range of groups and identities, they are being left with a choice: Vote for the people passing legislation that will severely curtail your quality of life, or vote for the people who aren’t.
For disabled people who fail to perform to society’s expectations about what disability should look like, there’s always been a looming threat in the form of rhetoric about people exploiting the system for benefits and treating disability as a free handout. In 2017, that rhetoric came home to roost, with a Republican-controlled Congress that finally felt free to expose how it really feels about disability.