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Trump’s Failed Coronavirus Response and Ongoing War on Health Care Is Especially Dangerous for People with Disabilities

By November 2, 2020No Comments

There are 61 million adults with a disability in the United States. According to the Centers for Disease Control and Prevention (CDC), adults with disabilities are three times more likely to have chronic conditions, like heart disease, diabetes, and cancer, that put them at higher risk for severe illness if they contract the coronavirus. Additionally, data has shown that people with intellectual disabilities are both contracting and dying from coronavirus at higher rates than people without disabilities.

People With Intellectual And Developmental Disabilities Are Seeing Higher Rates Of Infections and Deaths From Coronavirus. Early data revealed that people with intellectual/developmental disabilities were experiencing alarming rates of infections and deaths from the virus. Many of these individuals live in group settings or rely on direct care workers to meet their daily needs, increasing their likelihood of exposure to the virus. Individuals residing in congregate settings are particularly at risk: a growing body of research has shown that individuals residing in facilities are more likely to die from the virus. By May, more than one in five Illinoisans living in state homes for adults with disabilities had tested positive for coronavirus. A June 2020 NPR Analysis found that people with intellectual disabilities and autism in Pennsylvania and New York who test positive for coronavirus were dying at about twice the rate of the general public. Data has also indicated that children with intellectual and developmental disabilities are facing higher fatality rates from COVID-19.

President Trump’s Failure To Contain The Virus And To Shore Up Supplies To Fight COVID-19 Have Put People With Disabilities In Danger. As the virus surges and hospitals are overwhelmed, people with disabilities are in unique danger as supply shortages loom. Faced with increasing caseloads and acute supply shortages, some states have drafted guidelines for medical rationing to determine which patients are deserving of life-saving and limited supplies. These guidelines have, in some states, excluded people with disabilities from receiving equipment or treatment. As cases in Arizona surged this summer, disability rights groups filed a federal complaint that the state’s crisis standards discriminated against those with disabilities (as well as people of color and the elderly). The complaint suggested that people with disabilities would be perceived as having shorter life expectancy, thus making them less deserving of care. 

How President Trump Made Health Care Worse For People With Disabilities Ahead Of The Pandemic

Medicaid and the Affordable Care Act (ACA) remain critical sources of care for people with disabilities during this crisis. At a time when millions of people are facing the possibility of coronavirus and devastating health care bills, protecting coverage of our nation’s most vulnerable is more important than ever. However, Trump has spent his presidency sabotaging the ACA and Medicaid, undermining access to care for people with disabilities. 

Top Ways Trump Has Sabotaged Health Care For People With Disabilities

  • Trump Is Trying Repeal Medicaid Expansion And Protections For Pre-Existing Conditions Through His Lawsuit To Overturn The ACA. After trying and failing to repeal the ACA legislatively, the Trump administration is now backing a lawsuit to completely dismantle the health care law and, if they are successful, more than 20 million people would lose insurance, and protections for pre-existing conditions would be eliminated overnight. The lawsuit would also terminate Medicaid expansion, threatening to rip away coverage from 15 million people, including people with disabilities, and cut key funding for already-struggling rural hospitals during the pandemic.
  • Republican Efforts To Repeal Medicaid Expansion Would Mean 64 Percent Of Medicaid Adults With Disabilities Could Lose Coverage. Per the Center on Budget and Policy Priorities: “The Affordable Care Act’s Medicaid expansion covers 11 million people. Many of them struggle with a chronic illness or a disability (such as a mental health condition) that wouldn’t, by itself, qualify them for Medicaid. Only 36 percent of non-elderly Medicaid beneficiaries with disabilities receive Supplemental Security Income, which allows them to enroll in Medicaid even without the expansion.” 
  • The Trump Administration Is Encouraging States To Impose Work Requirements And Other Bureaucratic Restrictions On Medicaid Enrollment In Order To Deny Coverage. For years, Trump has empowered states to impose red tape and paperwork requirements as part of his ongoing efforts to dismantle Medicaid. Work requirements have been at the center of these efforts. After Arkansas imposed the nation’s first work requirements program, more than 18,000 residents lost Medicaid coverage. While work requirements have been blocked by a federal judge repeatedly, the Trump administration keeps fighting to impose these onerous rules in Medicaid. In addition to work requirements, the administration has encouraged states to impose other barriers such as increased eligibility verification as well as premiums and other cost-sharing. All of these efforts amount to blatant attempts to strip health care away from vulnerable Americans.
  • Requiring People To Work To Maintain Medicaid Coverage Is Particularly Burdensome For People With Disabilities. Though some states are claiming to exempt people with disabilities from their work requirements, these exemptions are narrow and leave many behind. Among those who should qualify for exemptions, work requirements make it more difficult to keep coverage by requiring enrollees to provide documentation, testimony, and records to prove they have disabilities.
  • Trump Wants To Gut The Medicaid Budget & Has Encouraged States To Pursue Harmful Block Grants. Trump has repeatedly sought deep health care cuts in his budget proposals, most recently seeking more than a trillion in cuts to Medicaid and the Affordable Care Act for 2021. This budget essentially ends Medicaid expansion by eliminating the enhanced federal payment and proposes nationwide work requirements. Under the Trump administration’s recently finalized block grant proposal, federal funding would no longer necessarily increase in response to a public health emergency like coronavirus. This could lead to people losing coverage and access to care, undermining prevention and treatment of diseases nationwide.
  •  President Trump Is Pushing Short-Term Junk Plans That Allow Insurance Companies To Discriminate Against People With Pre-Existing Conditions. The Trump administration expanded access to health plans that are allowed to discriminate against people with pre-existing conditions, meaning that people with disabilities could be left with devastating health care bills under these plans. These plans can also deny coverage for prescription drugs, preventative care, and other essential health benefits. Junk plans are particularly harmful during the coronavirus crisis: One analysis found widespread misleading marketing of short-term plans during the pandemic. Reports have already shown that patients covered by these plans have been left with thousands of dollars in medical bills for seeking treatment for coronavirus symptoms. 
  • President Trump And His Administration Have Refused To Reauthorize Money Follows the Person (MFP). In the 2019 budget, the Trump administration refused to reauthorize the Money Follows the Person program, which allows Medicaid beneficiaries to move from institutional settings into the community. The Administration’s refusal to extend MFP beyond the end of the year 2020, continues to put people with disabilities at risk.

Trump Is Still Fighting To Overturn The ACA

Overturning the ACA would be devastating for people with disabilities. The ACA ensures that insurance companies cannot deny coverage, drop coverage for no reason, or charge people more because of a pre-existing condition. The ACA’s Medicaid expansion also plays a key role in ensuring adults with disabilities are covered. It’s critical that Americans understand just what’s at stake if this outrageous and irresponsible lawsuit succeeds.

The Affordable Care Act Provided Health Security To People With Disabilities

The Affordable Care Act Prevents Insurance Companies From Charging Americans With A Disability More Or Denying Them Coverage Altogether. Prior to the ACA, insurance companies were allowed to charge people more or deny coverage simply because they had a pre-existing condition. The ACA banned this practice, requiring that insurance companies offer people coverage regardless of their health status.

Thanks To The Affordable Care Act, Insurance Companies Can No Longer Impose Annual And Lifetime Limits On Coverage. Before the ACA, insurance companies could restrict the dollar amount of benefits someone could use per year or over a lifetime. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million annually, functionally locking people with complex medical needs out of coverage. 

Under The ACA, Insurance Companies Can No Longer Practice Medical Underwriting, A Process That Let Insurers Make It Harder For People With Disabilities To Get The Coverage They Needed. Before the ACA, insurance companies could screen applicants for any conditions that might be costly to the company. If someone had condition that was predicted to cost the insurance company more, the insurance company would follow a practice called “medical underwriting” that allowed them to charge the applicant a higher premium, specifically exclude coverage for the condition that was expected to be costly, charge the applicant a higher deductible, or limit the applicant’s benefits (for instance, offer a policy that did not cover prescription drugs).

The ACA Requires Insurance Companies To Cover Basic Health Services. The Affordable Care Act established the ten essential health benefits, requiring insurance companies to cover rehabilitative or habilitative services, hospitalization, maternity care, prescription drugs, maternity care, and mental health services. Before the ACA, many people with disabilities had insurance that didn’t cover basic health care needs.

Eliminating Medicaid Expansion Would Harm The Disability Community

More Than 15 Million People Covered By Medicaid Expansion Could Lose Coverage. If the Texas Lawsuit succeeds, 15 million people—including individuals with disabilities— covered by Medicaid expansion will lose this coverage. 

Medicaid Is A Lifeline For People With Disabilities. Research has shown the people with disabilities covered by Medicaid are more likely to receive comprehensive and consistent care than those who are privately insured. Medicaid expansion has also been linked to increasing employment among individuals with disabilities. Protecting access to Medicaid, particularly during the pandemic, is essential to ensuring people with disabilities continue to get the care they need. 

  • 61 Million Americans Have A Disability. Without the Affordable Care Act, insurance companies could once again deny them coverage, drop their coverage for no reason, or charge them more because of a pre-existing condition. 
  • 8.7 Million Nonelderly Adults With Disabilities Depend On Medicaid For Care. Of this group, only 43 percent qualify for supplemental security income (SSI). The remaining 5 million beneficiaries do not receive SSI and therefore do not qualify for coverage based on their disability status alone, meaning they rely on the ACA’s Medicaid expansion or eligibility as low-income parents. 
  • More Than One In Three Medicaid Enrollees Under 65 Has A Disability. More than 1 in 3 adults under age 65 enrolled in Medicaid lives with at least one disability. 
  • 45 Percent Of Adults With Disabilities Have Medicaid Coverage. Medicaid covers 45 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illness.