President Joe Biden and His Promises to Disabled People
I don't know if it is possible to write about politics without getting political— but I'm darn sure going to try. I thought it was about time to look at how the Biden Administration is doing at keeping its promises to the disabled community. Because let's face it, politicians will promise you the moon when they want your vote, but the promises can be tossed into the ash heap of history once they get into office.
Sign language at press conferences
One of the easiest yet inclusive things an administration could do is make White House press briefings more accessible by providing American Sign Language interpreters. And yet, no President, before Joe Biden, did so. I think that says a lot about how he values access and inclusiveness.
On the other hand, maybe he saw the writing on the wall. In 2020, a federal judge ordered the previous administration to have ASL interpreters at the COVID-19 press briefings. Deaf and hard-of-hearing advocates have long advocated for ASL accommodation, so maybe Biden was simply trying to avoid another lawsuit.
Whatever true motivation Biden and his communication team had for finally addressing the lack of access to information for disabled people, I applaud their decision. Not only does it right a wrong, but it sends a message that the Biden Administration is at least trying to honor the promise of its platform, which states:
President Biden recognizes that we need to view all policies—ranging from climate change and the economy to education and housing—through an inclusive lens. He will ensure people with disabilities have a voice in their government and are included in policy development and implementation.
Finally, it sets a precedence that future administrations will have to follow and be an example for other municipalities around the country.
Rescinding Medicaid work requirements
In early 2018 the Trump Administration made good on its promise to kick low-income Medicaid beneficiaries off the federal healthcare program unless they went to work. It was a particular top priority for the administrator of the Center for Medicare and Medicaid Services, Seema Verma, as she encouraged state Medicaid directors to apply for waivers permitting them to create "community engagement requirements," a.k.a work quotas.
When I learned of this, coming out of a Republican White House, it didn't really surprise me. Conservatives have long had a desire to slash funding for Federal social safety net programs. It doesn't make it any less cruel, however.
The whole point of Medicaid is to provide health insurance for people who can't work due to age or disability. I was once a Medicaid recipient. And while I no longer qualify for Medicaid, I am still a Medicare recipient. Having this benefit has nothing to do with my desire to work. I am unable to work because of my disability. So I have strong opinions around the topic of work requirements.
I can't fully explain why most conservatives have this "pull yourself up by your bootstraps" mentality. This idea is that somehow if you need government assistance, you just aren't working hard enough. That you are lazy. It's a mentality that informs policies that are very harmful to people.
Because the facts run afoul of that biased narrative, it puts the health of the approximately 75 million people who rely on Medicaid as their single access to healthcare in jeopardy. The Kaiser Family Foundation has put together an informative list of 10 Facts About Medicaid. As the article points out, 1 in 5 Americans receive Medicaid, and for many, it is the only way they can pay for long-term care. A common misunderstanding is that most private insurers and Medicare pay for long-term care. They do not.
While those who want to cut off access to the program claim that only those deemed "eligible to work" would be subject to the employment quota, in my perspective, that is a slippery slope. For the most vulnerable of our population, who are already low-income, being "working poor" is very much a reality. Requiring them to work while also taking away their only access to healthcare ensures they will become sicker and probably die.
The government shouldn't be looking to curtail Medicaid's beneficiaries; they should be looking for ways to bolster and expand the program. Which, thankfully, in the early days of President Biden's Administration, he did. He made an order, rescinding the work requirements, and directed his new administrator of CMS to void any contracts the Federal government had made with states to allow for work-based Medicaid benefits. Additionally, he has committed to doing what he can (ideally with congressional approval) to strengthen the Medicaid program and expand its coverage for the millions of Americans who need it.
Because behind every statistic is a story. A story of a person or a family struggling to care for someone in need. Every person deserves to live a life with purpose, potential, and dignity. Taking away healthcare is the first and best way to ensure that can't happen. I know this country wants to do good for its people. I hope we will continue to elect leaders, regardless of political affiliation, who want that too. I will always have that hope. I'm proud to live in a country with a social safety net that I feel is an integral part of the moral fabric of this country. I can only hope it can grow stronger over time. Certainly, rescinding the arbitrary and cruel work requirements is an excellent first step in that direction.
Also noteworthy: while I have been primarily talking about Medicaid, there is also a crisis in the Medicare program. Applying for benefits and waiting for the approval process has typically been a months-long process, with several initial denials guaranteed. The pandemic however, has only made this wait even longer:
Amid the pandemic, the backlog of pending disability applications awaiting a decision rose by 30 percent, from 593,944 in 2019 to 763,747 last year. The processing times for applications increased by 11 days, meaning the average application took 131 days for the SSA to process. These delays have tangible consequences — from missed mortgage payments to increased rates of depression — which is why an increase in SSA funding could be a lifesaving measure for millions of Americans with disabilities.
Caregiving included as infrastructure
The third and final policy decision I wanted to address is President Biden's choice to make caregiving a signature part of his infrastructure bill. Specifically, the President proposes injecting $400 billion into the community-based services system as part of Biden's American Jobs Plan, a wide-ranging infrastructure proposal introduced in March.
When I learned of this, I was elated. Well, let's be honest, at first, I was kind of shocked. When was the last time you heard a President, Democrat or Republican, talk about caregiving in this country? Or even more so, the caregiving crisis unfolding in this country, right before our eyes? And then attempt to do something to address it in a meaningful and actionable way? Caregiving was highlighted during the Obama Administration when he worked to expand Home and Community-Based Services. But nothing like what President Biden is proposing.
Biden's inclusion of caregiving as a "human" infrastructure need, on the same level as roads, bridges, and buildings, is forward-thinking for a couple of reasons. The first reason is that it prioritizes the issue to make it easier to appeal for funding. If you can equate work as a commodity, it becomes more tangible in a budgetary framework. The second reason is it addresses a need on the federal level in policy language (i.e., congressional legislative language) that will get a lot more attention and publicity had it been just a stand-alone item.
Now with that attention, of course, comes scrutiny. I see it from a "glass-half-full/glass-half-empty" approach. The criticisms of making caregiving a "human infrastructure" issue are that the funding will not be targeted enough to help those who really need it. Conservatives see this as wasteful government spending— "pork" on another "social service" program. Liberals say that the plan doesn't go far enough. I see the glass as more full in that, even though whatever congressional legislation gets passed won't be perfect, at least it will be something.
I highly encourage you to read this NBC article, and this NPR article, that highlights the crisis in an up-close way by featuring families living through this crisis, and some sobering statistics that make me aware, as it should all people, that this an "everyone" problem. Here is one excerpt from the NPR piece:
The need
Statistics suggest that, at some point in their lives, 70% of older adults in the U.S. will require help with dressing, hygiene, moving around, managing finances, taking medications, cooking, housekeeping and other daily needs, usually for two to four years. As the nation's aging population expands to 74 million in 2030 (the year the youngest baby boomers reach age 65 ), that need will expand exponentially.
Younger adults and children with conditions such as cerebral palsy, blindness, or intellectual disabilities can similarly require significant assistance.
The burden on families
Currently, 53 million family members provide most of the care that vulnerable seniors and people with disabilities require — without being paid and often at significant financial and emotional cost. According to AARP, family caregivers, on average, devote about 24 hours a week to helping loved ones and spend around $7,000 out-of-pocket on that care.
This reflects a sobering reality: paying for long-term care services is even more expensive than providing the care themselves for most individuals and families. According to a survey last year by Genworth, a financial services firm, the hourly cost for a home health aide averages $24. Annually, assisted living centers charge an average of $51,600, while a semiprivate room in a nursing home goes for $93,075.
*note, I hate the word choice of "burden."
Because time is of the essence to address the needs of this broken caregiving system, this country is, in fact, in a caregiving crisis right now. COVID-19 has made an already challenging situation worse. Thus leaving millions of families stretched to the max in caring for their loved ones. And those with no family, abandoned. Biden's plan will help address this crisis. According to the White House, research shows that increasing the pay of direct care workers greatly enhances workers' financial security, improves productivity, and increases the quality of care offered. Another study showed that increased pay for care workers prevented deaths, reduced the number of health violations, and lowered the cost of preventative care.
Just the fact that caregiving has been brought before legislators and the national public as a significant issue affecting millions of American families is, as President Biden would probably say himself, "A big f*cking deal."
The origin of Uncle Joe's empathy
A part of me wonders if President Biden's focus on disabilities and caregiving is because he's had a shared experience with both. He has talked openly and frankly about the lifelong challenges he has had with a speech stutter. Additionally, he witnessed what his son Beau Biden went through with his brain cancer. While cancer, while itself not a disability, it and its treatments can cause disabling conditions, may have given Biden a unique insight that we are all human regardless of position or power. No one is magically protected from illness or injury. Therefore everyone should be afforded the ability to be cared for in a way that provides the most independence, comfort, and dignity possible. A robust social safety net can help ensure that happens.
Of course, Biden isn't the only President to advocate for disabled issues. It is common knowledge that while Franklin Delano Roosevelt didn't make his disability part of his public persona, having polio probably informed his perspectives on social service policy issues and especially helping those in poverty. Data shows that in 2019, 25.9 percent of disabled people were living in poverty, compared to 11.4 of non-disabled.
Then there was George H.W. Bush, a Republican, who signed the Americans with Disabilities Act into law. Yes, it was a bi-partisan effort, but a handful of his own party's members didn't vote for the law, and the business community and religious groups generally opposed it. Years later, another Republican President, George W. Bush, passed another law that helped elderly and disabled people on Medicare by passing Medicare Part D— the most sweeping healthcare legislation since Medicare itself. He, too, took a lot of heat from his own party. It was passed on a slim margin in the wee hours of a legislative session in 2003. Republicans blasted its price; Democrats said it was just a gift to big pharma. As a person who benefited from the law at the time, I think it was a good thing. No, it wasn't perfect, but it allowed me to purchase a supplemental health plan for my medicines for a very minimal premium and then covered 100 percent of my pharmacy costs. I could never have afforded to pay for my medication out of pocket.
Lastly, I want to conclude this post with a disclaimer that I know I don't have to include but will. Yes, I am liberal-leaning and a registered Democrat who votes the party line most of the time. This is not because of pure partisanship, but rather, that at the present moment, the Democratic Party is the one that aligns most with my values. When the Democratic Party and its candidates stop representing my values, I'll stop voting for them. And more importantly, vote for who is. I think it is essential to have options at the ballot box. I strongly support the two-party system because they create a needed check and balance on policymaking. I admire the multi-party systems of some European countries because they force coalition building. Only when you have people from opposing views come together to work on a common goal will the best result for a democratic republic be reached.
Elections in the United States happen every two years. That provides many opportunities to create a new representative government, one that hopefully propels us to a more perfect union. When there are significant issues such as access, healthcare, and lifting people out of poverty, I say it can't happen soon enough.