Election 2012

A Vote United

2012 Presidential Candidates Selected But Disability Platforms Still Unclear

Vote buttonThe primary season has closed, and our 2012 presidential candidates have been revealed. In November, ballots will be cast for the incumbent President Barack Obama, representing the Democratic party, and the GOP nominee, Mitt Romney. What’s still unclear, however, is where these candidates stand on issues relevant to the community of people with disabilities.

For a nonpartisan perspective, The Mobility Project talked to Paul Tobin, president and CEO of the United Spinal Association.

“Neither of (the candidates) have really put out concentrated disability platforms,” Tobin says. "The president has put out some things but not necessarily related to the campaign.”

Tobin says that voters can certainly consider Obama's history regarding people with disabilities.

"The president has taken some fairly novel approaches to disability in that there is for the first time under President Obama a presidential advisor on disability issues," he says. "So there is somebody actually at the White House concentrating on disability issues and how they relate to policy, and yet we still see within the administration significant cutbacks with things like durable medical equipment funding, restrictions on durable medical equipment (and) the perpetuation of the in-the-home rule."

In fact, Tobin says that Obama is more progressive on disability issues, but he has failed to translate this into policy. One example is the pool regulations set forth by the Americans with Disabilities Act (ADA) being put on hiatus.

"Both candidates have honestly taken positions that could be detrimental to the community," Tobin says.

What Are the Important Issues?

The presidential candidates have developed platforms on the usual hot-button issues for elections, but few of these issues coincide with what matters most to people with disabilities. Below is an overview of the important issues for the community of people with disabilities:

Medicaid, Medicare, and the Patient Protection and Affordable Care Act
Healthcare is definitely an area in which the candidates have been outspoken, especially regarding the recently approved Affordable Care Act.

The Affordable Care Act was developed under and signed by President Obama, which leaves little doubt where he stands on the legislation.

Through his campaign Web site—as well as a recent statement after the Supreme Court ruling—Romney has also been clear: "On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all fifty states. He will then work with Congress to repeal the full legislation as quickly as possible."

Romney proposes to hand power to states to distribute Medicaid and other payments and limit federal involvement in private insurance and Medicaid coverage. The site also states that Romney would work to prevent discrimination against those with preexisting conditions who maintain continuous coverage.

Whether it stays or goes, the Affordable Care Act has a huge impact on people with disabilities, especially in terms of healthcare insurance options and preexisting conditions.Barack Obama

If Obama is re-elected, Tobin says his organization will focus on how the program will be implemented—it's important that the community have a voice when it comes to those details.

For example, preexisting condition clauses typical of most insurance plans significantly impact people already diagnosed with mobility conditions. So the first question that needs to be asked regarding the Affordable Care Act is whether people with mobility conditions will be subjected to those same clauses, Tobin says.

In addition, patient-centered outcomes research generally drives the way programs such as Medicare make decisions, but research is based on the average American, not necessarily the average American with disabilities, Tobin says. As a result, funding for durable medical equipment (DME) and therapies that are beneficial for people with mobility conditions—even if no improvement is shown—can be and are currently disregarded.

In fact, the same people who are involved in Medicare decisions would be involved in the implementation of the Affordable Care Act, which means these types of issues could easily be built into policy.

"Basically, will we make headway trying to make sure that we can be integrated into a community, or will the way the Affordable Care Act is implemented, will that ultimately drive people back toward institutionalization by virtue of not having community-level services?" Tobin says.

Mitt Romney

If Romney is elected, the kinks in Medicare and Medicaid will need to be improved for people with disabilities, especially in terms of cuts to equipment, services and support. For example, Tobin says Illinois recently passed legislation that cuts back the number of outpatient physical, occupational, and speech language and hearing therapies to 20 visits per type of therapy.

"While that may be sufficient, that should really be deemed on a medical basis, not an arbitrary number like a maximum of 20 per year," Tobin says.

In addition, Illinois has moved toward prior authorization for wheelchair repairs.

"Imagine that for every tire or tube that has to be replaced on a wheelchair, there has to be a 6-week or 8-week adjudication process to determine whether or not you’re eligible for a new tire or a new tube," Tobin explains. "It’s not only administratively burdensome, but it is absolutely detrimental to the health and well-being of the individual wheelchair user."

Illinois, again, is trying to change the way wheelchairs are funded by absorbing the discounts that large-volume equipment suppliers get for buying in bulk, Tobin says. As a result, the amount of money that all suppliers would get paid for Medicaid reimbursement would be much less; the process would put many suppliers out of business, especially the ones not receiving these discounts, and reduce access for people who use medical equipment.

In general, Tobin has questions about the policy that pays for equipment only as it pertains to getting around inside the home. Neither candidate has been outspoken about his position regarding the in-the-home rule.

“I would be very curious to ask both candidates how the concept of the in-the-home rule exists in today’s United States of America,” Tobin said. “How can we basically subjugate an individual on confinement simply because of a physical disability?”

ADA and Transportation
Although the ADA has been in place for 22 years, enforcement remains an issue. For example, the fight last year regarding accessible taxis in New York called attention to a severe lack of access for people throughout metropolitan areas. And just this year, the Justice Department ruled to extend the timeline for hotels and other public entities to make pools accessible.

Tobin uses Amtrak as an example. “This is a federally subsidized program, and there’s still not accessibility to the extent that there should be.”

While Obama has supported the ADA, his policies leave questions about his commitment to enforcing the issues. While it is unclear where Romney stands regarding the ADA, several news organizations have reported that Romney previously vetoed legislation that would improve accessibility to elevators.

Home Care, DME and Community Support Services
Complex rehab technology is a key issue for this election. Currently, a proposed bill, H.R. 4371, has been introduced that would carve out complex rehab technology and customized DME from the Medicare program. Doing so would allow these devices to be reimbursed as the customized medical devices they are.

"In your general public, you’re told, ‘Don’t stare at the man in a wheelchair. Don’t look at the wheelchair. Don’t ask any questions.’" says Tobin. "It's only when somebody really knows somebody with a disability that they start to understand how … (a wheelchair) really facilitates so many activities and basically opens up a world of opportunity to the individual if it’s properly fitted and doesn’t otherwise compromise their health.

"But those kind of nuances are definitely lost upon most legislators who look at wheelchairs or believe them to be completely interchangeable—basically a chair with wheels and one is equivalent to another. And therefore, why should we be paying all this money for a device that they believe is basically pulled off the shelf and provided? Those who are familiar with the equipment know that it's much more complex."

Just as one piece of equipment is not suited for all people, equipment alone cannot solve all problems for people with disabilities. In fact, Tobin says community support services are equally important because they integrate people with disabilities into their communities, allow them to live independently and relieve families of the responsibility of being a constant caregiver. Yet conversations about increasing community support services are not happening to the extent that they should be.

Veterans are usually a key topic for presidential candidates, especially given the recent war in Iraq. Both candidates have supported benefits for veterans with disabilities. Obama has increased federal employment opportunities, and Romney has supported tax exemptions. In July, the Romney campaign announced that Chad Colley, former national commander of the Disabled Veterans of America, had endorsed the candidate.

It's clear that both candidates are actively seeking the vote of veterans with disabilities.

Unemployment has been at an all-time high in the United States over the past several years, and as such, this topic is definitely something candidates are talking about. What's rarely mentioned, however, is unemployment in the context of people with disabilities.

The American Association of People With Disabilities (AAPD) reports that 36 percent of working-age people with disabilities are employed vs. 77 percent of those without disabilities.

Obama, for one, has not let the topic go unnoticed. In response to an AAPD presidential candidate questionnaire, he said that he supports reauthorizing and strengthening the Workforce Investment Act to create equal opportunities for competitive, integrated jobs. In addition, the president referred to other programs that he has supported such as Add Us In that improves employment opportunities for people with disabilities as well as a new tax credit for employers who hire veterans with service-connected disabilities.

Last year, the president signed an executive order for the government to extend more job opportunities to people with disabilities.

At the same time, however, the government is under pressure to cut back on federal employment and payroll, explains Tobin. "I’m not sure how well the president’s initiative is actually doing in terms of hiring people with disabilities outside of the Veterans Administration, which is trying to hire a significant number of veterans with disabilities," Tobin says.

Accessible Housing
Another topic that Tobin believes should be introduced to the candidates is the lack of affordable accessible housing limiting community inclusion and independence among people with disabilities.

“There are indeed people who are either living with family, living in inaccessible housing or who are in institutions for want of affordable, accessible housing alternatives,” he said.

Why Does Your Vote Count?

Unfortunately, most presidential candidates fail to consider the disabled community in their campaigns, even though there are an estimated 54 million Americans with disabilities—and 1 million with paralysis—according to Tobin.

"Our community would most benefit from acting … with other disability organizations and heading up with a strong independent voice that talks about the needs of people with mobility impairments," he says. "We need to act as a voting bloc for things like … durable medical equipment and therapies and things of that nature that would basically enhance the quality of life and independence of the individuals who are affected by those conditions."

United Spinal has an outlet for people with disabilities to come together through its new User's First program. User's First is designed to connect people with many different types of disabilities, not only spinal cord injury, and help build a grassroots advocacy network.

"We don't need all 1 million individuals affected by a form of paralysis to join, but we certainly need the most vocal among us from every state in the union to be able to help organize local groups and try to explain the impact of these kind of cuts (to medical equipment and services) or restrictions upon our independence and then try to influence elections and make sure we elect people into office who are going to help us live as independently in the community as possible," Tobin says.

In addition, Tobin hopes to work with events such as the Complex Rehab Education & Legislative Forum (CELA) and organizations such as the National Registry of Rehabilitation Technology Suppliers (NRRTS) and National Coalition for Assistive and Rehab Technology (NCART) to ensure access to complex rehab technology and community services are maintained.

It is only through organization that future presidential candidates will start to see people with disabilities as a group that has a significant impact on the outcome of an election, Tobin says.

What Will the Candidates Say?

In the last presidential election, United Spinal teamed up with the AAPD to organize a debate for presidential candidates during the primaries. This year United Spinal will sponsor a similar forum currently in the works for September in Columbus, Ohio. Tobin says he hopes the forum can bring together both candidates to allow people with all types of disabilities to ask about where the presidential candidates stand on topics such as the Affordable Care Act and the ADA.

In addition, the 2012 Presidential Debates, which have changed in format, will provide more clarity on where each candidate stands. The new format will allow the presidential and vice presidential candidates to delve deeper into discussion of policies; candidates will debate a single topic for as long as 15 minutes instead of the quick bursts that have characterized past debates.

Below is a schedule of the 2012 Presidential Debates. Click here for updated debate information.

October 3, 2012
9:00-10:30 p.m. ET
University of Denver, Colo.
Topic: Domestic policy
Participants: President Barack Obama and Mitt Romney

October 11, 2012
9:00-10:30 p.m. ET
Centre College in Danville, Ky.
Topic: Foreign and domestic policy
Participants: Vice President Joe Biden and GOP vice presidential nominee*
*Mitt Romney has not yet announced his choice for vice president, although that announcement could come before or during the Republican National Convention set for Aug. 27-30.

October 16, 2012
9:00-10:30 p.m. ET
Hofstra University in Hempstead, N.Y.
Topic: Town meeting forum including foreign and domestic policy
Participants: President Barack Obama and Mitt Romney

October 22, 2012
9:00-10:30 p.m. ET
Lynn University in Boca Raton, Fla.
Topic: Foreign policy
Participants: President Barack Obama and Mitt Romney

What Decision Will You Make?

Regardless of which candidate you choose, the most important thing is that you cast your vote. Speaking up for yourself is not only a basic American right, it's also your responsibility as a citizen of this nation. If you have not already registered to vote, do so now.

And while you're at it, consider uniting your voice with others through United Spinal Association's User's First.

The bottom line is the actions you take—as well as the ones you don't—can influence this and future elections. It's time for people with mobility conditions to send that message to Washington.

Presidential Questionnaire

The American Association of People With Disabilities (AAPD) recently asked presidential candidates to respond to a questionnaire about equal opportunities, including their plans to reduce unemployment, end barriers to education and community inclusion, and protect the right to vote. President Barack Obama has responded. Read his response here. To date, Mitt Romney has not responded. Contact his campaign here to encourage him to answer these important questions.