Donald Trump made his disregard for the 1 in 5 Americans with disabilities abundantly clear when he mocked a disabled New York Times reporter to a crowd of thousands at a campaign rally. But now that he’s in the White House, that disregard is no longer restricted to hateful words. Now, President Trump’s administration—together with his Republican colleagues in Congress—are pursuing policies that would put the health, education, and economic security of people with disabilities and their families at grave risk while further enriching both the wealthy and corporations through massive tax cuts.
New analysis by the Center for American Progress shows that more than 15 million people with disabilities, including children and seniors, would be at risk under President Trump’s and House Republicans’ proposed Medicaid cuts.* Many could be pushed out of their homes and into costly and isolating institutions as a result. But that’s just the tip of the iceberg.
Here are five ways Trump’s agenda would be a disaster for people with disabilities and their families.
1. Trump’s health care plan would push millions with disabilities into institutions
Perhaps no item sits higher on President Trump’s to-do list than repealing the Affordable Care Act, or ACA. While the ACA has delivered broad benefits for children, families, and the nation as a whole, it has been particularly critical for people with disabilities and serious health conditions. Importantly, the law’s prohibition of discrimination on the basis of preexisting conditions has enabled cancer survivors, children with asthma, and seniors with diabetes to access affordable coverage and care. And its elimination of lifetime limits has cut off an all too common pathway to bankruptcy for families with a sick loved one. In addition to taking health insurance away from up to 21 million Americans, ending these protections would be particularly devastating for people with disabilities and health conditions as well as their families.
Meanwhile, despite President Trump’s promises during the campaign not to cut Medicaid, Congressional leaders’ ACA replacement plan—which Trump supports—would not only roll back Medicaid expansion, but it would also end the program’s guarantee of coverage by converting it into a block grant or instituting a per capita cap on federal funds provided to states to cover eligible residents. States would be forced to either make up the difference or—much more likely—kick people off their Medicaid programs. Notably, people with disabilities who rely on home- and community-based services through Medicaid—such as personal-attendant care, skilled nursing, and specialized therapies—could lose access to the services they need in order to live independently and remain in their homes. Proponents of this plan claim it would provide “flexibility” to states. But, in reality, it is a recipe for setting the nation back 50 years, when people with disabilities commonly lived in institutions instead of in their own communities.
2. Trump’s policies would make it harder for people with disabilities to work
In his first joint address before Congress, President Trump bemoaned low levels of labor force participation, though the numbers he cited significantly overstated the problem. Yet his policies would only erect further barriers to work for people with disabilities, a community that already faces much lower rates of labor force participation and significantly higher rates of unemployment than their nondisabled peers. Medicaid’s home- and community-based care services don’t just allow people with disabilities to live independently—they also enable many to work outside the home. Medicaid’s in-home services can also make it possible for family members who care for a loved one with a disability or serious illness to remain employed. Rolling back Medicaid expansion and further weakening the program by making it into a block grant or instituting per capita caps, as President Trump and his colleagues in Congress have proposed, would thus risk a return to widespread institutionalization and push even more people with disabilities—and their family members—out of the workforce.
Other cuts that President Trump and his colleagues in Congress are pushing could put employment even further out of reach for workers with disabilities. The federal-state Vocational Rehabilitation program, which assists people with disabilities in preparing for, obtaining, and/or remaining at work—has long been inadequately funded, leading to lengthy waitlists and extensive delays before eligible individuals receive needed services in many states. But President Trump’s massive defense budget increase would force deep cuts in this and other vital work and training programs. This comes on top of President Trump’s federal hiring freeze, which has been particularly painful for people with disabilities, who are disproportionately likely to be employed in federal jobs, as well as for veterans, who make up 40 percent of new federal hires. Meanwhile, President Trump’s paid leave proposal abandons people who need leave due to either their own disability/illness or that of a family member.
Furthermore, Trump and his colleagues in Congress continue to oppose raising the federal minimum wage; Trump even said on the campaign trail that he thought wages were “too high.” People with disabilities are disproportionately likely to work minimum-wage jobs, and some 400,000 are paid pennies an hour for their labor due to an antiquated provision in the Fair Labor Standards Act that permits employers to pay workers with disabilities a “subminimum wage.” For these and other reasons—such as employment discrimination—workers with disabilities face a steep wage gap, earning just 63 cents on the dollar on average compared to their nondisabled peers.
3. Trump’s education plan would harm students with disabilities
President Trump’s education plan centers around providing families with a voucher to send their child to the school of their choosing, often a private school. While proponents of the voucher model—including Secretary of Education Betsy DeVos—often hail them as providing “school choice,” voucher programs either remove or erode the rights and protections that students with disabilities are otherwise guaranteed under federal law. Specifically, these protections are provided by the Individuals with Disabilities in Education Act, or IDEA, a law whose protections DeVos admitted she knew little about during her confirmation hearings. Voucher programs generally require parents to waive their child’s educational rights, leaving schools without the obligation to provide needed supports and services the student would be legally entitled to receive in a public school and allowing them to deny admission to or remove students with disabilities if they determine they cannot accommodate students’ needs. And even if needed supports and services are made available, parents are frequently required to pay extra for their children to access them, whereas in public schools, all necessary services must be provided free of charge. What’s more, Trump’s and Congressional leaders’ plans to slash Medicaid would have consequences inside the classroom as well, as Medicaid provides important supports and services to students eligible for special education whose disabilities or health care needs affect their performance in school.
4. Trump would slash programs that provide basic living standards
People with disabilities already face poverty rates nearly three-times higher than their nondisabled counterparts. And they are much more likely to experience material hardships—such as inability to pay rent, mortgage, or utilities; inability to afford needed medical care; and food insecurity—than people without disabilities at the same income levels. In fact, more than half of working-age adults with incomes below 200 percent of the federal poverty line experiencing material hardships have a disability. Yet President Trump’s proposed increase in defense spending, which he describes as “one of the largest … in American history,” will force massive cuts in essentially all nondefense programs. These cuts would affect a variety of programs, including infrastructure, medical research, education and job training, nutrition assistance, affordable housing, and more—programs that are already funded at record-low levels as a share of the economy. Meanwhile, Congressional Republicans—led by Speaker of the House Paul Ryan (R-WI)—are seeking to slash programs that ensure basic living standards, such as the Supplemental Nutrition Assistance Program, or SNAP—formerly known as food stamps—housing assistance, and the Social Services Block Grant, which funds services for adults and children with disabilities. Cuts to these vital programs would push economic security even farther out of reach for people with disabilities struggling on the financial brink.
What’s more, despite Trump’s repeated promises not to cut Social Security, his colleagues in Congress are taking aim at a critical part of the Social Security system for people with disabilities known as Supplemental Security Income, or SSI. In his “A Better Way” plan released last June, Speaker Ryan called for eliminating the SSI program for children with disabilities altogether and providing services in lieu of income assistance. While SSI benefits are modest, averaging less than $650 per month for a disabled child, they provide critical income support to the families of 1.2 million children, helping them meet the costs of caring for a child with a disability, replacing lost parental income due to caregiving needs, and making it possible for families to care for their children at home instead of needing to send them away to costly and isolating institutions. SSI also represents an investment in children’s long-term potential, as a growing body of research shows that boosting poor family incomes during childhood improves health, education, and employment prospects in the long run.
5. Trump’s administration would weaken disability rights and protections
In addition to removing critical legal protections in the health care arena put in place by the ACA—such as prohibiting discrimination on the basis of a preexisting condition—President Trump and his colleagues in Congress are also considering gutting access to legal services, which would hit people with disabilities especially hard. Reports of a “hit list” of programs that Trump’s budget office plans to eliminate include the Legal Services Corporation, which helps low- and middle-income people access legal representation through civil legal aid—including people with disabilities who have been wrongfully denied needed services. Federally authorized Protection and Advocacy programs, often called P&As—another major source of legal help for people with disabilities facing problems such as employment discrimination, denial of special education services, or failure to provide needed accommodations—will also likely face the axe under Trump’s across-the-board budget cuts.
Meanwhile, we may no longer be able to rely on either the U.S. Department of Justice or the courts to protect and enforce disability rights under the Trump administration. In 2000, Attorney General Jeff Sessions lambasted the IDEA while still in the Senate, blaming the law for “the decline in civility and discipline in classrooms all over America.” And Judge Neil Gorsuch, Trump’s Supreme Court nominee, has evinced an extremely narrow view of not only the IDEA but also the Americans with Disabilities Act, going so far as to condemn the very use of lawsuits to enforce civil rights statutes. What’s more, Republicans in Congress are currently advancing legislation that would make it more difficult to bring class actions, which serve as a critical tool for enforcing disability rights under the law.
President Trump campaigned on helping struggling Americans, crediting “the forgotten American man and woman” with his election. And just a few weeks ago, Trump tweeted, “No-one has done more for people with disabilities than me.” But the policies his administration and his colleagues in Congress are advancing say otherwise. If Trump were serious about helping the workers and families who’ve been left behind—including millions of Americans with disabilities and their families—he would reject policies that undermine health care, education, and other basic living standards; push people out of the labor force as well as from their homes into institutions; and erode enforcement of disability rights in favor of a policy agenda that gives people with disabilities and their families a fair shot.
Rebecca Vallas is the Managing Director of the Poverty to Prosperity Program at the Center for American Progress. Katherine Gallagher Robbins is the Director of Family Policy for the Poverty to Prosperity Program. Jackie Odum is a Research Associate for the Poverty to Prosperity Program.
*Note: Authors’ calculations using American Community Survey, or ACS, 2015 one-year estimates via IPUMS-USA. As surveys often traditionally undercount Medicaid recipients, this is a conservative estimate. Due to the way the ACS reports Medicaid enrollees, this figure includes a small percentage of individuals whose health insurance coverage is through a different income-based public medical assistance program, such as the Children’s Health Insurance Program, which is also at risk under President Trump and Congressional leaders’ health care plans.