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	<title type="text">Sara Luterman | Vox</title>
	<subtitle type="text">Our world has too much noise and too little context. Vox helps you understand what matters.</subtitle>

	<updated>2020-03-16T18:00:40+00:00</updated>

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				<name>Sara Luterman</name>
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			<title type="html"><![CDATA[Why businesses can still get away with paying pennies to employees with disabilities]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/identities/2020/3/16/21178197/people-with-disabilities-minimum-wage" />
			<id>https://www.vox.com/identities/2020/3/16/21178197/people-with-disabilities-minimum-wage</id>
			<updated>2020-03-16T14:00:40-04:00</updated>
			<published>2020-03-16T08:30:00-04:00</published>
			<category scheme="https://www.vox.com" term="Explainers" /><category scheme="https://www.vox.com" term="Politics" />
							<summary type="html"><![CDATA[As we head into the endgame of the Democratic primary, it may not seem like the remaining candidates have very much in common. Former Vice President Joe Biden has campaigned for a return to the comfort and normalcy of the Obama era, while Sen. Bernie Sanders is asking for a revolution and fundamental changes to [&#8230;]]]></summary>
			
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<img alt="" data-caption="Demonstrators hold a banner that reads “Disability Rights are Human Rights” during the Non-March For Disabled Women in New York City on January 19, 2019. | Barbara Alper/Getty Images" data-portal-copyright="Barbara Alper/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/19799732/GettyImages_1098006690.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Demonstrators hold a banner that reads “Disability Rights are Human Rights” during the Non-March For Disabled Women in New York City on January 19, 2019. | Barbara Alper/Getty Images	</figcaption>
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<p>As we head into the endgame of the Democratic primary, it may not seem like the remaining candidates have very much in common. Former Vice President Joe Biden has campaigned for a return to the comfort and normalcy of the Obama era, while Sen. Bernie Sanders is asking for a revolution and fundamental changes to how American government functions. And yet there are a handful of issues upon which they agree, not only with each other, but with a surprising number of not-at-all-moderate Republicans. One of those shared issues: Ending below-minimum wage for people with disabilities.&nbsp;</p>

<p>Under a little-known regulation called 14(c) of the Fair Labor Standards Act, businesses can apply for permits to pay disabled employees well below the federal minimum wage of $7.25 an hour. That amount can dip down to mere pennies in some cases. In one particularly galling story from a <a href="https://ncd.gov/sites/default/files/NCD_Sub%20Wage_508.pdf">2012 report from the National Council on Disability</a>, an Ohio woman who had promised to take her family out to dinner with her first paycheck was sad and surprised to find out she had only earned 38 cents for the entire pay period.&nbsp;</p>

<p>Over the past decade, though, there has been a quiet battle raging to end the practice. Both Sanders and Biden have pledged to do away with below-minimum wage for people with disabilities.&nbsp;And even under the Trump administration and in some red states, the fight to end subminimum wage, as it&rsquo;s called in policy terms, has not been deterred.</p>

<p>Last year, Texas <a href="https://thehill.com/homenews/state-watch/448024-texas-governor-signs-bill-requiring-disabled-workers-be-paid-at-least#:~:text=">banned state contracts</a> with organizations that pay less than the federal minimum wage. Meanwhile, one of the biggest advocates for ending subminimum wage is Rep. Cathy McMorris Rodgers, previously the highest-ranking Republican woman in the House. McMorris Rodgers is also one of the most reliable votes for President Trump&rsquo;s agenda. She has supported Trump&rsquo;s tax cuts, consistently gets an A rating from the NRA, and recently appeared on a podcast put out by the Heritage Foundation to <a href="https://www.dailysignal.com/2019/03/01/rep-mcmorris-rodgers-shares-her-pro-life-convictions-the-science-is-on-our-side/">promote a new restriction on abortion</a>. She is also a cosponsor, along with Democratic Rep. Alexandria Ocasio-Cortez, on the <a href="https://www.congress.gov/bill/116th-congress/house-bill/873/cosponsors?q=%7b%22search%22:%5b%22Transformation+to+Competitive+Employment+Act%22%5d%7d&amp;r=1&amp;s=2&amp;searchResultViewType=expanded&amp;KWICView=false">latest legislation to stop this exception to the minimum wage</a>.&nbsp;</p>

<p>Part of how McMorris Rodgers and Ocasio-Cortez ended up on the same side of an issue: Disability is not constrained by concerns like class, race, religion, or any of the other demographic divisions that often form political opinion. Anyone can become disabled. Anyone can have a disabled child. McMorris Rodgers&rsquo;s son Cole has Down syndrome. In 2017, McMorris Rodgers told <a href="https://www.rollcall.com/2017/05/31/childrens-disabilities-inform-mcmorris-rodgers-and-hassan/">Roll Call</a>, &ldquo;You want to do everything you can so your child has every tool to succeed.&rdquo;</p>
<h2 class="wp-block-heading">The history of subminimum wages</h2>
<p>In 1937, President Franklin Delano Roosevelt first called for the enactment of a federal minimum wage, resulting in the Fair Labor Standards Act of 1938. During the hearings for the legislation, Labor Secretary Frances Perkins asked for a subminimum wage for people she called &ldquo;substandard workers,&rdquo; who she defined as &ldquo;persons who by reason of illness or age or something else are not up to normal production.&rdquo; It soon became clear that &ldquo;substandard workers&rdquo; and &ldquo;or something else&rdquo; would be interpreted in the worst possible ways. Some in Congress argued that people in the Southern United States should be paid less than minimum wage on account of being &ldquo;slower.&rdquo; Others argued that black workers were intrinsically &ldquo;substandard,&rdquo; according to <a href="https://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1211&amp;=&amp;context=key_workplace&amp;=&amp;sei-redir=1&amp;referer=https%253A%252F%252Fwww.google.com%252Furl%253Fq%253Dhttps%253A%252F%252Fdigitalcommons.ilr.cornell.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%25253D1211%252526context%25253Dkey_workplace%252523%253A%257E%253Atext%25253D%2526sa%253DD%2526ust%253D1583811576706000%2526usg%253DAFQjCNFRCED9aPZwt3RMmxmzdTBTtDZXnA#search=%22https%3A%2F%2Fdigitalcommons.ilr.cornell.edu%2Fcgi%2Fviewcontent.cgi%3Farticle%3D1211%26context%3Dkey_workplace%23%3A%7E%3Atext%3D%22">a report from the Congressional Research Service</a>.&nbsp;</p>

<p>Subminimum wage for disabled people, unlike these other recommendations, was uncontroversial. Over the years, disabled people have remained one of the few groups to be given subminimum wage.&nbsp;</p>
<img src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/19799474/GettyImages_3350976.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="" title="" data-has-syndication-rights="1" data-caption="In 1938, Labor Secretary Frances Perkins asked for a subminimum wage for “substandard workers”, which came to be interpreted in the worst possible ways. | London Express/Getty Images" data-portal-copyright="London Express/Getty Images" />
<p>Subminimum wage for some specific categories of workers, like<strong>&nbsp;</strong><a href="https://www.theatlantic.com/business/archive/2015/09/prison-labor-in-america/406177/">prisoners</a>, <a href="https://lawecommons.luc.edu/cgi/viewcontent.cgi?article=1150&amp;context=facpubs">agricultural</a>, and <a href="https://www.motherjones.com/environment/2016/04/restaurants-tipping-racist-origins-saru-jayaraman-forked/">tipped workers</a>, was designed with racial bias in mind. Restaurants and rail operators <a href="https://www.motherjones.com/environment/2016/04/restaurants-tipping-racist-origins-saru-jayaraman-forked/">embraced tipping</a> because it allowed them to save money by not paying newly freed slaves.</p>

<p>However, these laws do not explicitly single out people of color as a class for subminimum wage. Julie Christensen, the policy and advocacy director for the <a href="https://apse.org/">Association of People Supporting Employment First</a>, said to this day, disabled people remain the only group of people who can be paid below minimum wage based on an indelible trait. &ldquo;Disability is the only exemption based on class of citizen,&rdquo; she told Vox.</p>

<p>Additionally, unlike subminimum wage for agricultural and tipped workers, there is no floor for how little a<strong> </strong>disabled person can be paid. Instead, people are paid based on how productive they are, or rate per piece. The rate is set as a percentage of a non-disabled person&rsquo;s productivity.</p>

<p>So, if a non-disabled person makes 100 widgets an hour at $7.25 an hour and a disabled person makes 20 widgets an hour, that disabled person receives $1.45 an hour. Additionally, if productivity is down for reasons unrelated to a person&rsquo;s disability, like poor management or short stock, the person still receives their wage based on rate per piece. So their wage may be extremely low for arbitrary reasons beyond the person&rsquo;s physical capacity or control. (Meanwhile, non-disabled people are not always at peak productivity, and it is not legal or acceptable to pay them less when they have an off day.)&nbsp;</p>

<p>According to Christensen, subminimum wage for disabled people wasn&rsquo;t nefarious by design. It was originally intended to serve as a transition for the large number of disabled soldiers returning from the world wars. Eventually, people were supposed to be able to work themselves up to full productivity before graduating out of the sheltered workshop &mdash; a segregated, disabled-only workplace that is supposed to double as job training for disabled people</p>

<p>However, instead of their original intended use, subminimum wage and sheltered workshops have become permanent for many disabled workers, especially those with intellectual disabilities. Despite being classified as &ldquo;vocational rehabilitation,&rdquo; few ever graduate to the mainstream working world. According to a 2001 audit from the Government Accountability Office, only 5 percent of sheltered workshop employees ever transition to outside jobs with normal pay.</p>

<p>In addition to simple lack of opportunity, there are numerous financial incentives to keep people employed in subminimum wage for the rest of their working lives. <a href="https://www.youtube.com/watch?v=tl5DDS8I3fQ">Ross Ryan</a>, an Oregon man with an intellectual disability, stayed at a sheltered workshop for 22 years until a class action lawsuit shut it down. &ldquo;I was not given choices growing up, and this led to me feeling trapped in a sheltered workshop for most of my adult life.&rdquo;</p>

<p>Social service providers for disabled people were, from the beginning, the largest industry represented in 14(c). This meant that they had a dual role as people who were supposed to be providing some level of care and support to disabled people, as well as being the bosses of disabled people.<strong> </strong></p>

<p>Due to disability, their workers were often extremely poor and were ignored by organized labor. This created a conflict of interest that persists to this day. Large nonprofits like <a href="https://www.youtube.com/watch?v=GznAli633yA">Goodwill</a> can provide cheaper clothes in their thrift stores, and organizations like SourceAmerica are able to make a bigger profit margin and deliver goods and services through lucrative government contracts for a fraction of the cost, because they can legally pay their labor force pennies an hour.&nbsp;</p>
<h2 class="wp-block-heading">The long fight against subminimum wages</h2>
<p>The first challenge to subminimum wages came in the 1960s during an explosion of the expansion of civil rights for many marginalized groups in America. The National Federation of the Blind led the charge.</p>

<p>Sen. Wayne Morse, a Democrat from Oregon, proposed bringing the &ldquo;moderately disabled&rdquo; up to full minimum wage during a three-year transition period and that wages for the &ldquo;severely disabled&rdquo; be at least half of the federal minimum wage. Employers of disabled people being paid subminimum wage, like Goodwill, called it &ldquo;unrealistic&rdquo; and &ldquo;a drain on the economy&rdquo; during <a href="https://books.google.com/books?id=lA82AAAAIAAJ&amp;pg=PA1331&amp;lpg=PA1331&amp;dq=%22Senate+Subcommittee+on+Labor%22%2B+%221965%22%2B+%22disabled%22&amp;source=bl&amp;ots=cwxDc9P02l&amp;sig=ACfU3U2BYo9_trhWTRGT-XVfJaSmNprV7Q&amp;hl=en&amp;sa=X&amp;ved=2ahUKEwjxlqTXooToAhVzZTUKHSekBwoQ6AEwAHoECAkQAQ#v=onepage&amp;q&amp;f=false">Senate hearings</a>. They also claimed that the change would deprive the &ldquo;severely disabled&rdquo; of the opportunity to work. These are the same criticisms leveled by supporters of subminimum wage decades later.</p>

<p>More challenges came soon after. Since the 1970s, there have been several attempts to alter or end subminimum wage. All of them have gone nowhere.</p>

<p>During one 1980 hearing before the House Subcommittee on Labor Standards, Jerry Daugherty of the National Industries for the Severely Handicapped claimed, &ldquo;more important than wages to the disabled, is the opportunity to work.&rdquo;</p>

<p>He and others representing subminimum-wage nonprofits and businesses argued that disabled people did not need real payment because they were supported by Social Security and other government benefits instead. His argument was apparently convincing, and subminimum wage continued more or less unchanged.</p>
<img src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/19799493/GettyImages_515513426.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="" title="" data-has-syndication-rights="1" data-caption="Sen. Wayne Morse (D-OR) proposed increasing the minimum wage for disabled workers in the 1960s. Employers called the proposal “unrealistic.” | Bettmann Archive/Getty Images" data-portal-copyright="Bettmann Archive/Getty Images" />
<p>There have, however, been some advances. In the late &rsquo;60s, the <a href="http://mn.gov/mnddc/ada-legacy/ada-legacy-moment17.html">Self-Advocacy Movement</a> &mdash; the first political rights organization by and for people with intellectual disabilities &mdash; formed, and by 1974 the movement had spread to the United States. More and more people with intellectual disabilities were being moved out of large state institutions and into<strong> </strong>everyday society as deinstitutionalization ramped up. Faced with freedom, some people seized the opportunity to advocate for themselves and the rights of people like them.&nbsp;</p>

<p>Then, in 1988, the <a href="https://apse.org/about/history/">Association of People Supporting Employment First</a> was formed using newly created federal grants from the US Department of Education. Forty states received grants to help people find and maintain ordinary jobs in the community, rather than in traditional subminimum wage sheltered workshops.&nbsp;</p>

<p>But it wasn&rsquo;t until 1990 that the crowning achievement of disability civil rights policy was passed. The Americans with Disabilities Act included provisions intended to end discrimination against hiring disabled people and to legally require accommodations like ramps and screen readers. Unfortunately, it has had <a href="https://douthat.blogs.nytimes.com/2010/07/29/did-the-americans-with-disabilities-act-work/">seemingly little impact</a> in terms of improving the unemployment rate for disabled people.&nbsp;</p>

<p>However, what the ADA did do was cement disability rights as a bipartisan issue. The ADA and ensuing amendments have been <a href="https://thehill.com/opinion/civil-rights/405655-bipartisan-consensus-on-our-human-frailty-the-ada-amendments-act-10">championed by Democrats and Republicans alike</a>. While some major aspects of disability policy, like Medicaid, have become <a href="https://www.vox.com/policy-and-politics/2017/6/22/15855424/disability-protest-medicaid-mcconnell">extremely politically charged</a>, much disability policy is still the purview of both parties.&nbsp;</p>

<p>In 2002, Vermont became the <a href="http://www.startribune.com/vermont-took-bold-step-to-end-segregation-of-disabled-adults/330697181/">first state to abolish subminimum wage</a>. In addition to being first, they&rsquo;ve been one of the most successful. Not only is there no longer subminimum wage, but they also have the highest rate of employment and the highest median annual income for people with intellectual and developmental disabilities in the country.&nbsp;</p>

<p>Ari Ne&rsquo;eman, a former Obama appointee to the National Council on Disability, told Vox that Vermont is considered by many experts to be a model for disabled employment. Ne&rsquo;eman was especially struck by the shift in sentiment. &ldquo;Years later, many of the same people who had opposed workshop closure had come to see it as a blessing and as the beginning of greater opportunities for their loved ones,&rdquo; he said.&nbsp;</p>
<h2 class="wp-block-heading">The number of subminimum wage workers are dwindling. But where are they going?</h2>
<p>The movement against subminimum wage has been picking up steam slowly but surely since Vermont made the first leap. In the past five years alone, there&rsquo;s been more than a 56 percent drop in the number of disabled people being paid less than minimum wage for their work.&nbsp;</p>

<p>Part of the decrease is simply a result of more and more states banning subminimum wage for disabled people, or at least significantly limiting the practice. From Alaska to Texas,&nbsp;21 states already have some limit on the books to subminimum wage for disabled people. In the 2020 legislative session alone, <a href="http://www.startribune.com/minnesota-advocates-seek-to-abolish-subminimum-wages-for-people-with-disabilities/568249102/">nine</a> <a href="https://whatsuprhodeisland.com/2020/02/legislative-news-feb-25-child-care-as-election-expense-wages-for-disabled-workers-cap-on-cost-of-prescription-insulin/">more</a> <a href="https://www.chicagoreporter.com/after-goodwill-controversy-spotlight-on-subminimum-wage/">states</a> are set to address the issue. <strong>&nbsp;</strong></p>

<p>What is unclear, however, is where those workers are going instead. The unemployment rate for disabled people has <a href="https://www.nber.org/papers/w10740">remained static</a> since the Americans with Disabilities Act passed in 1990. Not everyone who leaves a sheltered workshop automatically gets a mainstream job. So how does 100,000 people leaving sheltered workshops not impact the unemployment rate?</p>

<p>The answer is that the basic unemployment rate is not actually an estimate of the number of people who are or aren&rsquo;t working. That measure is the number of people who are actively looking for work and who have previously been employed for at least six months. People in sheltered workshops being paid subminimum wage are counted as employed. But people who have simply given up looking for work after leaving the sheltered workshop or who have never worked in the first place don&rsquo;t exist in unemployment calculations. They seemingly disappear.&nbsp;</p>

<p><a href="https://docplayer.net/33593240-Transitions-a-case-study-of-the-conversion-from-sheltered-workshops-to-integrated-employment-in-maine.html">Some research</a> hints that more people are entering adult day care programs instead of sheltered workshops. Whether that&rsquo;s an improvement is disputed, even within the movement to end subminimum wage.</p>

<p>Julie Christensen feels strongly that it is not. &ldquo;From APSE&rsquo;s perspective, we don&rsquo;t want people ending up in [adult day care] programs,&rdquo; she said. It isn&rsquo;t enough just to end subminimum wage. Real victory for the disability community will mean increasing the number of disabled people in the mainstream workforce.</p>

<p>&ldquo;Unemployment is going to fluctuate with the economy. That&rsquo;s just life,&rdquo; Christensen said. &ldquo;We want to close the employment gap. We want people with disabilities to be working at the same rate as people without disabilities.&rdquo;</p>

<p>Importantly, the level of disability a person has is not necessarily related to whether that person can get and maintain a mainstream job. <a href="https://www.kcrg.com/content/news/Dubuque-father-son-center-of-question-during-Democratic-presidential-debate-566388561.html">Bill Stumpf&rsquo;</a>s son, Kyle, who has Down syndrome and does not speak, has been <a href="https://www.wsaz.com/content/news/People-with-disabilities-can-be-paid-less-than-minimum-wage-but-some-want-to-change-that-566488051.html">successfully employed at a Papa John&rsquo;s</a> in Dubuque, Iowa, for five years, after leaving a sheltered workshop. Stumpf said that initially, like many parents, he had been afraid of what would happen to Kyle if the sheltered workshop closed. &ldquo;Change is hard,&rdquo; he said. But Stumpf said that Kyle loves his new job. &ldquo;You can see it in his face,&rdquo; Stumpf said. &ldquo;He basically runs to the car when it&rsquo;s time to go to work.&rdquo;&nbsp;</p>

<p>For Shawn Fulton, who said he prefers not to be referred to by his disability &mdash; &ldquo;I&rsquo;m just Shawn&rdquo;&nbsp;&mdash; the turning point was getting involved in the Self-Advocacy Movement. He had previously been employed in a sheltered workshop for 25 years, where he was paid half a cent per piece to grind bits of metal. He still doesn&rsquo;t know what the bits of metal were used for.&nbsp;&nbsp;</p>

<p>&ldquo;I started learning about how I can get out and work,&rdquo; he said. &ldquo;I owe it all to self-advocacy.&rdquo; He now works as an education and training coordinator at the <a href="https://www.arcind.org/">Arc of Indiana</a>, teaching other people with intellectual disabilities how to better advocate for what they want in life. Shawn called working for the Arc of Indiana &ldquo;the greatest thing that ever happened to [him].&rdquo;&nbsp;</p>
<h2 class="wp-block-heading">The fate of the subminimum wage lies with Congress</h2>
<p>There are currently two bills in Congress that address subminimum wage. The first, the <a href="https://www.vox.com/2019/8/16/20807610/raise-the-wage-act-15-minimum-wage-bill">Raise the Wage Act</a>, pledges to raise minimum wage for all workers, including those with disabilities, to $15 an hour. It passed the Democratic House, and senators including presidential candidate Bernie Sanders have cosponsored it, but the bill <a href="https://www.vox.com/2019/8/16/20807610/raise-the-wage-act-15-minimum-wage-bill">seems unlikely to move in the Senate</a>. Christensen praised the inclusion of disabled people in the bill, but &ldquo;most people don&rsquo;t even realize [ending the subminimum wage for people with disabilities] is in there.&rdquo; She said it also does not build the capacity needed to get disabled people into the mainstream workforce.&nbsp;</p>

<p>Instead, Christensen is enthusiastic about the <a href="https://www.congress.gov/bill/116th-congress/house-bill/873?q=%7B%22search%22%3A%5B%22Transformation+to+Competitive+Employment+Act%22%5D%7D&amp;s=2&amp;r=1">Transformation to Competitive Employment Act</a>, which would provide for a phase-out period and build capacity to make sure disabled people currently working for subminimum wage don&rsquo;t fall through the cracks. &ldquo;How do we make such a significant shift and simultaneously do the least harm? There aren&rsquo;t enough direct support professionals, there aren&rsquo;t enough job coaches. If we woke up tomorrow and everyone in a 14(c) setting needed a job coach, that wouldn&rsquo;t exist,&rdquo; she said.</p>
<img src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/19799527/GettyImages_1147198406.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="" title="" data-has-syndication-rights="1" data-caption="Rep. Alexandria Ocasio-Cortez works at a bar in Queens, New York, on May 31, 2019, to raise awareness for the One Fair Wage campaign, which calls to raise the federal minimum wage for tipped workers to a full minimum wage. | Drew Angerer/Getty Images" data-portal-copyright="Drew Angerer/Getty Images" />
<p>The Transformation to Competitive Employment Act would address these problems. With the House bill cosponsored by Reps. McMorris Rodgers and Ocasio-Cortez, it is considerably more likely to pass than the Raise the Wage Act, with broad, bipartisan support.&nbsp;</p>

<p>A fair wage for disabled people is &ldquo;much more than just a paycheck,&rdquo; McMorris Rodgers told Vox.&nbsp;&ldquo;It&rsquo;s a foundation for a better life.&rdquo;&nbsp;</p>

<p>So far, however, the Senate version of the bill has not been cosponsored by any of the senators currently or previously running for president &mdash; Bernie Sanders and Elizabeth Warren included &mdash; except Kamala Harris.</p>

<p>Biden, though, has endorsed the bill. He also answered the <a href="https://www.aapd.com/wp-content/uploads/2020/03/Vice-President-Biden_AAPD-and-NCIL-Presidential-Questionnaire.pdf">American Association of People with Disabilities questionnaire</a> in early March, which gives a small glimpse into what a Biden administration&rsquo;s disability policy might look like, since he still hasn&rsquo;t released a <a href="https://www.vox.com/first-person/2020/2/3/21119557/joe-biden-disability-plan">comprehensive disability plan</a>. (In contrast, Sanders and former presidential candidate Pete Buttigieg submitted theirs last year<strong> </strong>and both put out detailed disability plans.) While most of Biden&rsquo;s answers seem focused on restoring Obama-era policies, subminimum wage is one significant area where Biden is willing to take a step forward.&nbsp;</p>

<p>Meanwhile, Sanders&rsquo;s campaign told Vox that in addition to supporting legislative solutions like the Raise the Wage Act, Sanders would be open to exploring the use of executive power to end subminimum wages. He could, theoretically, tell the Department of Labor to stop issuing and renewing subminimum wage certificates. This would force a phase-out period and end subminimum wages for disabled people. The use of executive power isn&rsquo;t totally unprecedented &mdash; Vermont and Maine simply declined to renew certificates for subminimum wage as part of their strategies to abolish it.&nbsp;</p>

<p>While Biden and Sanders are in agreement about curbing subminimum wages, their wildly different approaches are an illuminating look into how each might choose to govern. While Sanders is willing to explore radical and nontraditional avenues to get the job done, Biden is interested in consensus-driven bipartisan legislation &mdash; as rare as that is these days. In the coming weeks, it will become clearer who will lead the Democratic Party in the election, but one way or another, the subminimum wage will be on the agenda.&nbsp;</p>

<p><em>Sara Luterman is a Washington, DC-based freelance journalist and commentator. She writes about disability politics, research, and culture. Her work has appeared in the Washington Post, Slate, the New York Times, and Undark Magazine, among other outlets. Follow her on&nbsp;</em><a href="https://twitter.com/slooterman"><em><strong>Twitter</strong></em></a><em>.</em></p>
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			<title type="html"><![CDATA[Biden is the only frontrunner without a disability plan]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/first-person/2020/2/3/21119557/joe-biden-disability-plan" />
			<id>https://www.vox.com/first-person/2020/2/3/21119557/joe-biden-disability-plan</id>
			<updated>2020-02-03T14:05:34-05:00</updated>
			<published>2020-02-03T11:30:00-05:00</published>
			<category scheme="https://www.vox.com" term="2020 Presidential Election" /><category scheme="https://www.vox.com" term="Politics" />
							<summary type="html"><![CDATA[In a tight Democratic primary race, disability rights has emerged as a leading issue. Sens. Elizabeth Warren and Amy Klobuchar, and former South Bend, Indiana, Mayor Pete Buttigieg have all released extensive plans, reflecting their visions for improving the lives of disabled Americans. On Friday, Sen. Bernie Sanders joined them with an audacious plan of [&#8230;]]]></summary>
			
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<img alt="" data-caption="Former Vice President Joe Biden speaks in Iowa a day before the 2020 presidential caucus. | Justin Sullivan/Getty Images" data-portal-copyright="Justin Sullivan/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/19666137/GettyImages_1203600323.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Former Vice President Joe Biden speaks in Iowa a day before the 2020 presidential caucus. | Justin Sullivan/Getty Images	</figcaption>
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<p>In a tight Democratic primary race, disability rights has <a href="https://www.wbur.org/hereandnow/2020/01/16/disability-rights-2020-democrats">emerged as a leading issue</a>. <a href="https://elizabethwarren.com/plans/disability-rights-and-equality?source=soc-WB-ew-tw-rollout-20200102">Sens. Elizabeth Warren</a> and <a href="https://medium.com/@AmyforAmerica/senator-klobuchars-plan-to-protect-equal-rights-and-provide-opportunity-for-people-with-a65288df570a">Amy Klobuchar</a>, and former South Bend, Indiana, Mayor <a href="https://peteforamerica.com/policies/access/">Pete Buttigieg</a> have all released extensive plans, reflecting their visions for improving the lives of disabled Americans. On Friday, Sen. Bernie Sanders joined them with <a href="https://berniesanders.com/issues/fighting-for-disability-rights/">an audacious plan</a> of his own. Disabled Iowans will go to the polls today knowing where most of the frontrunners stand on their issues. The only serious candidate without a detailed disability rights plan? Joe Biden.&nbsp;</p>

<p>It&rsquo;s worth noting that billionaires Tom Steyer and Mike Bloomberg don&rsquo;t have disability rights plans, either. To quote Vox&rsquo;s Kelsey Piper on <a href="https://www.vox.com/2019/1/29/18201005/tom-steyer-billionaires-president-democratic-debate">billionaires running for president</a>: &ldquo;[They&rsquo;re] very unlikely to win, it&rsquo;s not clear [they] have the skills to do the job well, and there are much, much better ways to make a difference with [their] billions.&rdquo; So it&rsquo;s not surprising that they haven&rsquo;t put much effort into drafting policy.&nbsp;Meanwhile, fellow entrepreneur <a href="https://www.vox.com/first-person/2019/12/19/21026925/andrew-yang-disability-policy">Andrew Yang</a> does have some disability policies outlined. But when it comes to the centerpiece of his campaign, a universal basic income, the details on how disability benefits would be affected are a bit unclear.</p>

<p>Biden, on the other hand, is a seasoned political veteran and a serious contender. While he has <a href="https://twitter.com/JoeBiden/status/1154919415554727936">touted his support</a> for the Americans With Disabilities Act on social media, he has not yet released a disability plan. When asked about this, his national press secretary told Vox that Biden will release a plan that builds on his support for legislation like ADA and the Affordable Care Act but did not clarify when. Currently, on his website under disability, there is a <a href="https://joebiden.com/disabilities/">placeholder page</a> in which Biden promises to fully fund the Individuals With Disabilities Education Act &mdash; a promise every other Democratic frontrunner has either made or exceeded, including Steyer.&nbsp;</p>

<p>The lack of details matter. Disabled voters need to be able to make informed decisions about our lives. We want to know about where a candidate stands on deinstitutionalization and tackling <a href="https://www.thedailybeast.com/medicaid-will-give-you-money-for-at-home-care-but-you-might-wait-years">waiting lists for home care</a>. We want to know how a candidate might handle the issue of <a href="https://www.vox.com/2016/10/4/13161396/disability-police-officer-shooting">police violence against disabled people</a>, particularly disabled people of color. In Iowa, disabled caucus-goers (<a href="https://www.nytimes.com/2020/01/26/us/politics/iowa-caucuses-disabilities.html">at least those who can access the caucus at all</a>) do not have a full set of facts with which to make their decisions.&nbsp;</p>

<p>Biden has also said little to nothing about disability in public. In <a href="https://www.theatlantic.com/magazine/archive/2020/01/joe-biden-stutter-profile/602401/">interviews</a> and during debates, he has <a href="https://www.vox.com/2019/12/20/21031333/joe-biden-stuttering-sarah-sanders-democratic-debate">discussed his stutter</a>. But personal experience is not a substitute for an informed, systemic approach. People who stutter don&rsquo;t apply for Medicaid or Social Security because of it. People don&rsquo;t rely on home health aides to get dressed in the morning or worry about being confined to nursing homes because they stutter. Despite having a disability, Joe Biden is largely insulated from some of the more difficult, systemic, and policy-reliant parts of life for many disabled Americans. Simply having a disability does not make someone an expert on disability policy or an advocate for disability rights.&nbsp;</p>

<p>Biden seems to have made &ldquo;electability&rdquo; the key selling point of his candidacy. The question of whether Biden can beat President Trump in the general election is frustrating. Asking whether a candidate is electable is very much like asking what color a candidate&rsquo;s aura is &mdash; maybe there&rsquo;s something there and I&rsquo;m just not able to see it, or maybe there&rsquo;s nothing there and people are just seeing what they want to see. &ldquo;Electability&rdquo; is not measurable. It doesn&rsquo;t give a sense of what a candidate values or who they might recruit to lead with them. It&rsquo;s a claim without substance or basis beyond poll numbers, and we all know <a href="https://www.nytimes.com/2018/09/20/upshot/polling-2018-midterms-elections-challenge.html">polls can be misleading</a>. After all, Hillary Clinton polled better than Trump <a href="https://fivethirtyeight.com/features/election-update-dont-ignore-the-polls-clinton-leads-but-its-a-close-race/">right up until the votes came in</a>.&nbsp;</p>

<p>That leaves us with candidates&rsquo; policy plans and the company they keep to evaluate who they are and what they value. Joe Biden has <a href="https://www.ebony.com/news/black-staff-matters-behind-the-scenes-biden-2020-team/">stressed the diversity of his staff</a>, and it is probably the most attractive aspect of his candidacy right now. But most of the candidates have exceptionally talented, diverse teams. If Biden&rsquo;s staff is full of seasoned former Obama appointees and experienced professionals, it&rsquo;s not unreasonable to expect them to do and be better.&nbsp;</p>

<p>Biden has released some detailed policy plans before the Iowa caucuses &mdash; like his <a href="https://joebiden.com/empowerworkers/">plan for organized labor</a> and his <a href="https://joebiden.com/gunsafety/">plan for gun violence</a>. However, disability rights was apparently not important enough to roll out before voting begins. In contrast, <a href="https://www.thenation.com/article/archive/elizabeth-warren-disability-rights/">Warren</a> and <a href="https://twitter.com/i/events/1218231310113787904">Buttigieg</a> have engaged directly with grassroots disabled advocates through community institutions like <a href="https://www.wbur.org/hereandnow/2019/05/27/disability-advocates-2020-election">#CripTheVote</a> and have expansive plans addressing everything from wheelchair damage during air travel to the school-to-prison pipeline. Sanders has made disability rights part of his closing argument in Iowa for why he should be the Democratic candidate, even including specific provisions addressing the state&rsquo;s <a href="https://www.iowapublicradio.org/post/state-withhold-44-million-iowa-total-care#stream/0">Medicaid managed care disaster</a>.&nbsp;</p>

<p>There&rsquo;s still time for Biden to release his disability rights plan &mdash; it&rsquo;s not Super Tuesday yet. The candidate who will represent the Democratic Party in the general election has not been chosen. But disabled voters in Iowa won&rsquo;t have the privilege of knowing Biden&rsquo;s position on the issues that are most important to them before they cast their ballots. Biden&rsquo;s relative silence on disability may have been normal and acceptable in past years, but this election cycle, disability matters. Biden needs to catch up with the rest of the candidates and tell voters where he stands.&nbsp;&nbsp;</p>

<p><em>Sara Luterman is a Washington, DC-based freelance journalist and commentator. She writes about disability politics, research, and culture. Her work has appeared in the Washington Post, Slate, the New York Times, and Undark Magazine, among other outlets. Find her on Twitter </em><a href="https://twitter.com/slooterman"><em>@slooterman</em></a><em>. </em></p>
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			<author>
				<name>Sara Luterman</name>
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			<title type="html"><![CDATA[Andrew Yang wants to sell you universal basic income. Beware if you have disabilities.]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/first-person/2019/12/19/21026925/andrew-yang-disability-policy" />
			<id>https://www.vox.com/first-person/2019/12/19/21026925/andrew-yang-disability-policy</id>
			<updated>2020-02-03T13:41:01-05:00</updated>
			<published>2019-12-19T11:10:00-05:00</published>
			<category scheme="https://www.vox.com" term="Future Perfect" />
							<summary type="html"><![CDATA[Some people have treated entrepreneur Andrew Yang like a joke candidate &#8211; including, to some extent, Yang himself. He has skateboarded and crowd-surfed on the campaign trail. He has Super Nintendo on his tour bus and celebrated the opening of his New Hampshire office by shooting whipped cream directly into a fan&#8217;s mouth. Said the [&#8230;]]]></summary>
			
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<img alt="" data-caption="Democratic presidential candidate Andrew Yang speaks at the South Carolina Democratic Party State Convention on June 22, 2019 in Columbia. | Win McNamee/Getty Images" data-portal-copyright="Win McNamee/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/16676862/andrew_yang_GettyImages_1157608230.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Democratic presidential candidate Andrew Yang speaks at the South Carolina Democratic Party State Convention on June 22, 2019 in Columbia. | Win McNamee/Getty Images	</figcaption>
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<p>Some people have treated entrepreneur Andrew Yang like a joke candidate &ndash; including, to some extent, Yang himself. He has <a href="https://www.dailydot.com/layer8/andrew-yang-skateboard/">skateboarded</a> and <a href="https://www.washingtonpost.com/video/politics/watch-andrew-yang-crowd-surf-with-supporters/2019/09/10/ecbbaa26-056f-4f1f-a666-69709cb9d013_video.html">crowd-surfed</a> on the campaign trail. He has Super Nintendo <a href="https://twitter.com/erickmsanchez/status/1204564705416757248?s=20">on his tour bus</a> and celebrated the opening of his New Hampshire office by shooting whipped cream <a href="https://twitter.com/chrisdonato04/status/1202004748892884994?s=20">directly into a fan&rsquo;s mouth</a>. Said the <a href="https://www.bostonherald.com/2019/12/08/andrew-yang-having-fun-but-his-message-is-serious/">Associated Press</a>: &ldquo;Of all the many Democrats running for president, Andrew Yang is having the most fun.&rdquo;&nbsp;</p>

<p>Andrew Yang&rsquo;s success, however, demands that Americans take him seriously as a candidate. Unfortunately, he and his campaign make this task difficult, particularly when it comes to disability policy. Every <a href="https://www.forbes.com/sites/howardgleckman/2019/11/25/buttigieg-proposes-an-ambitious-and-much-needed--long-term-care-reform-plan/#1ad591dd7b01">major</a> <a href="https://corybooker.com/issues/health-care/policy-page/">candidate</a> has addressed the issue of care for disabled and elderly Americans. And while no platform is perfect, most candidates have a basic understanding of the social safety net, or at least their advisers do. Except maybe Yang&rsquo;s.</p>

<p>On Monday, Yang finally released his <a href="https://www.yang2020.com/blog/a-new-way-forward-for-healthcare-in-america/">health care policy plan</a>, with a section on people with disabilities. I read it. I also read his book, <em>The War on Normal People</em>, combed his website on details about disability programs, and asked his campaign for comment. And as a disabled person who has relied on various social safety net programs in the past, I am still left confused as to how disability benefits would be affected by the centerpiece of Yang&rsquo;s policies, <a href="https://www.vox.com/2014/9/8/6003359/basic-income-negative-income-tax-questions-explain">universal basic income</a>, or what he calls the Freedom Dividend. His health care policies for disabled people also raise more questions than answers.</p>
<h2 class="wp-block-heading"><strong>How Yang’s Freedom Dividend affects disability benefits</strong></h2>
<p>With the Freedom Dividend, the government would pay every American $1,000 per month, no strings attached. This is unlikely to ever make it through Congress. But let&rsquo;s say, for the sake of argument, that it did. Then what would happen to disability benefits?&nbsp;</p>

<p>It is difficult to analyze the impact of the Freedom Dividend on other social safety net programs like Social Security, Medicaid, or food stamps. Andrew Yang&rsquo;s new health care plan and the &ldquo;Care for People with Disabilities&rdquo; section say absolutely nothing on the matter. When Vox contacted Yang&rsquo;s campaign for clarification, his national press secretary insisted that Yang&rsquo;s plan &ldquo;touches on aspects&rdquo; of disability benefits, but did not explain how or in what way. I was repeatedly given answers and sent links to parts of the website that were totally irrelevant to the questions I&rsquo;d asked.&nbsp;</p>

<p>A major issue for how the Freedom Dividend might impact disability benefits is whether a program will &ldquo;stack&rdquo; with it. That is, whether a person will still be able to receive their existing benefits while also receiving the Freedom Dividend. While Yang does outline some social programs that will &ldquo;stack&rdquo; &mdash;&nbsp;like Social Security retirement benefits &mdash; it is an incomplete list.</p>

<p>For many of the programs he omits &mdash;&nbsp;like SNAP (better known as food stamps) or housing vouchers &mdash; a person has to demonstrate a certain amount of financial hardship in order to qualify. While the Freedom Dividend should hypothetically be available to everyone, his campaign&rsquo;s loose grasp on what benefits disabled people even use in the first place suggests it may not.</p>

<p>For example, <a href="https://www.yang2020.com/what-is-freedom-dividend-faq/">the FAQ on universal basic income</a> on Yang&rsquo;s website includes basic errors. It notes: &ldquo;some people who receive more than $1,000 a month in SSI would choose to take the Freedom Dividend because it has no preconditions.&rdquo; This means they they can opt-in without having &ldquo;to deal with a degrading and paternalistic bureaucracy,&rdquo; Yang&rsquo;s national press secretary told me. However, the problem with this statement is that it conflates SSI, Supplemental Security Income, with SSDI, Social Security Disability Insurance, which encompass very different things.</p>

<p>SSDI consists of cash payments to people who have a disability that prevents them from having a job. The amount of money a person gets from SSDI is based on work credits &mdash; the longer a person has worked and the higher the person&rsquo;s previous wage, the more money that person may be entitled to.</p>

<p>SSI, on the other hand, is for people who are poor or disabled and who do not have the work experience necessary to qualify for SSDI. Yang&rsquo;s point about people who receive more than $1,000 a month in SSI is particularly nonsensical because it is impossible to receive more than $1,000 per month in SSI. The <a href="https://www.ssa.gov/ssi/text-benefits-ussi.htm">maximum allowed federal rate</a> for an individual in 2019 is $771. Of course, $1,000 is more than $771, so it may seem, on the surface, that Yang is essentially offering a $229 increase in benefits to the 3.4 million Americans who rely on SSI. And who couldn&rsquo;t use a little more money? To paraphrase a Yang campaign slogan, &ldquo;math!&rdquo;&nbsp;</p>

<p>Unfortunately, much like the policy, the math isn&rsquo;t that simple.</p>

<p>Many states require that people qualify for SSI in order to receive government-funded long-term services and supports through Medicaid. If a quadriplegic person requires an aide to get out of bed, get dressed, and get showered every morning, that person needs to either qualify for SSI to get those services, or pay for them out of pocket &mdash; an incredibly expensive proposition.</p>

<p>Most jobs simply don&rsquo;t pay enough to cover basic needs, like rent and food, on top of personal assistance that can cost <a href="https://www.kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/">upward of $45,000 a year</a>. Many disabled and elderly people <a href="https://www.vox.com/2014/12/9/7319477/medicaid-disability">purposefully impoverish themselves</a>, turning down paid work and emptying their savings accounts in order to qualify for services they need just to get out of bed in the morning. Experts call this <a href="https://www.ncbi.nlm.nih.gov/pubmed/17096639">the poverty trap</a>.&nbsp;</p>

<p>It is unclear whether choosing the Freedom Dividend over SSI would impact access to these necessary services. Yang&rsquo;s website doesn&rsquo;t say, and after several exchanges, Yang&rsquo;s spokesperson eventually sent me a link to the FAQ, which, again, doesn&rsquo;t answer the question. It&rsquo;s unclear if taking the Freedom Dividend might cause someone to lose access to the benefits they need to stay alive.&nbsp;</p>
<h2 class="wp-block-heading"><strong>How Yang’s health care plan helps people with disabilities</strong></h2>
<p>Yang&rsquo;s other mentions of disability are bizarrely and arbitrarily limited. In his official disability policy platform titled &ldquo;<a href="https://www.yang2020.com/policies/care-for-people-with-disabilities/">Care for People with Disabilities</a>,&rdquo; Yang calls for ensuring wheelchair accessibility, but only for hospitals, and with no explanation as to how he would do so. He calls hearing aids and mobility devices &ldquo;preventative care services &hellip; to prevent further secondary conditions.&rdquo; Hearing aids help with hearing loss in a pretty straightforward way, so I&rsquo;m not sure what secondary conditions Yang&rsquo;s platform is talking about.&nbsp;</p>

<p>Regarding questions on long-term services and supports for people with disabilities, Yang&rsquo;s campaign insisted that their plan &ldquo;touches on aspects of it.&rdquo; A spokesperson did not explain which aspects when pressed.&nbsp;</p>

<p>Yang&rsquo;s campaign was similarly opaque on whether he supports Medicare for All. On one hand, <a href="https://www.yang2020.com/policies/medicare-for-all/">it&rsquo;s listed on his website</a> as a key part of his policy platform. But in his expanded health care plan, he notes, &ldquo;swiftly reformatting 18% of our economy and eliminating private insurance for millions of Americans is not a realistic strategy,&rdquo; a direct reference to the single-payer plans proposed by Sens. Bernie Sanders and Elizabeth Warren. Instead, Yang boldly declares, &ldquo;We are having the wrong conversation about healthcare.&rdquo; But what is the right conversation? For Yang, it&rsquo;s shifting the &ldquo;focus away from funding mechanisms and budget towards solving the major problems within the healthcare system.&rdquo;</p>

<p>Instead of a comprehensive plan addressing access to health care and insurance affordability like the ones proposed by the other frontrunners, he addresses a mishmash of seemingly unconnected issues, from telemedicine to tort reform to electronic medical records. It is unclear why some issues warrant Andrew Yang&rsquo;s attention and not others. Sure, making HIV prevention medication and reproductive health care more widely available are worthy goals, but there&rsquo;s no coherence or overarching policy.&nbsp;</p>

<p>This dedication to the arbitrary when it comes to disability extends beyond the borders of Yang&rsquo;s health care plan. The first bullet point on Yang&rsquo;s <a href="https://www.yang2020.com/policies/mental-health/">mental health plan</a>, for example, is to begin a national anti-stigma campaign for mental health issues called &ldquo;Everybody Needs Help Sometimes.&rdquo; Yang also calls for incentives for improved mental health outcomes.</p>

<p>The thing is, some people need help all the time. Incentives for improved mental health outcomes are not useful for those of us who will never be &ldquo;well.&rdquo; Yang&rsquo;s <a href="https://www.yang2020.com/policies/autism-intervention-funding/">autism policy</a> also seems strangely short-sighted, considering his own son is <a href="https://www.cnn.com/2019/11/03/politics/andrew-yang-evelyn-yang-2020-campaign-president/index.html">on the spectrum</a>. He calls for more funding for early diagnosis and therapy for children, but autism is not a childhood condition. Yang does not have a proposal for when autistic people <a href="https://www.autism-society.org/living-with-autism/autism-through-the-lifespan/">inevitably grow up</a>. He makes the same call for other disabilities in his <a href="https://www.yang2020.com/policies/care-for-people-with-disabilities/">wider disability policy platform</a>, and it is equally, bafflingly limited.&nbsp;</p>

<p>As one of only seven candidates who have qualified for the <a href="https://www.vox.com/policy-and-politics/2019/11/20/20974318/how-to-watch-december-democratic-debate-6th-pbs-politico-2020-election">Democratic debate this week</a>, Yang is still in this race. But the caucuses and primaries in Iowa and New Hampshire are approaching, and as the Democratic field tightens, candidates face increased scrutiny over their policies. Yang certainly has big ideas, but big ideas are not enough to improve the lives of Americans with disabilities. He needs to understand the fundamentals before proposing radical systemic change. And it is abundantly clear, given the existing evidence, that he does not.&nbsp;</p>
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			<entry>
			
			<author>
				<name>Sara Luterman</name>
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			<title type="html"><![CDATA[How Kamala Harris’s mental health plan could hurt the most vulnerable]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/first-person/2019/11/27/20985430/kamala-harris-mental-health-plan" />
			<id>https://www.vox.com/first-person/2019/11/27/20985430/kamala-harris-mental-health-plan</id>
			<updated>2019-11-27T12:47:18-05:00</updated>
			<published>2019-11-27T12:50:00-05:00</published>
			<category scheme="https://www.vox.com" term="Kamala Harris" /><category scheme="https://www.vox.com" term="Politics" />
							<summary type="html"><![CDATA[In August, Sen. Kamala Harris was praised for being the first 2020 presidential candidate to announce a plan on general disability community policy. It was clear the Harris campaign had engaged in a thoughtful discussion with community leaders about what matters to its members. But on Monday, when Harris&#8217;s campaign rolled out its mental health [&#8230;]]]></summary>
			
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<img alt="" data-caption="Sen. Kamala Harris (D-CA) speaks at Howard University after announcing her campaign for president. | Al Drago/Getty Images" data-portal-copyright="Al Drago/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13707921/GettyImages_1085868896_lead.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Sen. Kamala Harris (D-CA) speaks at Howard University after announcing her campaign for president. | Al Drago/Getty Images	</figcaption>
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<p>In August, Sen. Kamala Harris was praised for being the <a href="https://www.forbes.com/sites/sarahkim/2019/08/30/kamala-harris-disability-plan/#256a99841234">first 2020 presidential candidate</a> to announce a <a href="https://medium.com/@KamalaHarris/kamalas-commitment-to-full-inclusion-and-civil-rights-for-people-with-disabilities-7cfd8adb512">plan</a> on general disability community policy. It was clear the Harris campaign had engaged in a thoughtful discussion with community leaders about what matters to its members. But on Monday, when Harris&rsquo;s campaign rolled out its <a href="https://kamalaharris.org/policies/mental-health/full-policy/">mental health policy plan</a>, it had not been nearly so thoughtful. Harris seems to have gone all-in on attacking the freedom, dignity, and privacy of people with mental health conditions. People like me.&nbsp;</p>

<p>In 2014, I voluntarily admitted myself to a psychiatric hospital while deeply suicidal. What followed was one of the most harrowing and dehumanizing experiences of my life. I wasn&rsquo;t allowed to decide what to eat, what to do all day, or what to wear in any meaningful way. I was talked over like I wasn&rsquo;t there.&nbsp;</p>

<p>In some inpatient psychiatric treatment programs, you can refuse to do the things expected of you, but that just gets you labeled &ldquo;non-compliant,&rdquo; and there are consequences. You can be strip-searched or have what few belongings you have pawed through for any reason. There is an ever-present threat of violence that staff are allowed to use against you. No one will question it, and no one will believe you if you complain, because you&rsquo;re crazy. Nothing you say matters.&nbsp;&nbsp;</p>

<p>My experience was better than the experiences of my friends. I was never physically restrained by staff or locked up alone, both of which happened to others during my time in the locked ward. I was fortunate to have family support and good health insurance. I cannot imagine how much worse the experience would have been for me, how long I might have gotten trapped in the system, if I did not. Inpatient psychiatric care is a world in which rights are just suggestions, and where staff exert an exceptional amount of control over every aspect of your life.&nbsp;</p>

<p>Harris&rsquo;s plan touts making such treatment &ldquo;accessible&rdquo; to more people, whether we like it or not. &ldquo;Accessibility&rdquo; is a celebrated word in disability rights. It represents ramps, large print, and sign language interpreters &mdash;&nbsp;accommodations and adaptations that help people with disabilities fully participate in the world. The &ldquo;access&rdquo; promised in Harris&rsquo;s plan is to locked wards, forced drugging, and the denial of the same right to privacy afforded to other Americans. Her proposed policy distorts &ldquo;access&rdquo; beyond recognition.&nbsp;</p>

<p>Overall, the language Harris uses in her plan is astonishingly Orwellian. Promising &ldquo;mental health care on demand,&rdquo; &ldquo;[increasing] access,&rdquo; and &ldquo;ending the mental illness to jail pipeline&rdquo; all sound good on the surface, but the devil is in the details. For example, to address &ldquo;access to hospitals, housing, and other care facilities,&rdquo; Harris proposes repealing something called the Institutions for Mental Disease exclusion.</p>

<p>The IMD exclusion is a longstanding policy under Medicaid that prevents the use of Medicaid funding to pay for inpatient care in facilities with more than 16 beds. Essentially, what it does is prevent government funding for insane asylums. Harris&rsquo;s plan euphemistically calls these Medicaid-funded insane asylums &ldquo;psychiatric assisted living campuses.&rdquo;&nbsp;</p>

<p>For the past 50 years, America has been undergoing de-institutionalization, a move to treat mental health conditions in the community rather than sequestering people from normal society. Allowing Medicaid to pay for asylums would financially incentivize turning back the clock on <a href="https://www.aclu.org/other/aclu-history-mental-institutions">decades of civil rights work</a> by people with mental health conditions and our allies. The Trump administration has been <a href="https://slate.com/news-and-politics/2018/11/medicaid-imd-exclusion-state-waivers-inpatient-mental-health-services.html">chipping away at the IMD exclusion</a> for years and recently called to <a href="https://apnews.com/b0b1034de6d24fd4b0dd2f9367442449">bring back asylums</a> as a response to gun violence. One would think that being on the same side of an issue as the president would give Democratic primary candidates pause.&nbsp;</p>

<p><a href="https://peteforamerica.com/policies/mental-health-and-addiction/">South Bend, Indiana, Mayor Pete Buttigieg</a> and <a href="https://medium.com/@AmyforAmerica/amys-plan-to-combat-addiction-and-prioritize-mental-health-b0207531c9ab">Sen. Amy Klobuchar</a> have proposed repealing the IMD exclusion in their mental health and addiction plans. Harris&rsquo;s plan, however, takes measures several steps further. Under the heading &ldquo;End the mental illness to jail pipeline,&rdquo; Harris proposes expanding funding for assisted outpatient treatment programs. These programs paternalistically allow courts to require a person to undergo mental health treatment. Harris is, essentially, asserting that people have a right to be forcibly medicated. The <a href="https://www.treatmentadvocacycenter.org/storage/documents/aot-cost-study.pdf">report her plan links to</a> as a source states that doing so is &ldquo;cost effective.&rdquo;&nbsp;</p>

<p>The medications typically prescribed in AOT programs are antipsychotics and mood stabilizers. These drugs can be beneficial for people with certain conditions like bipolar disorder or psychosis. However, over the course of a year, only half, on average, <a href="https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.159.1.103">will continue taking the drugs</a>. This is not because people are stupid or lack insight into their own illness. Antipsychotics and mood stabilizers tend to have heavy side-effect profiles.&nbsp;</p>

<p>For example, <a href="https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149866">common side effects</a> include drowsiness and major weight gain. A less common but alarming side effect is tardive dyskinesia, a lack of control over muscle movements. Mood stabilizers can cause kidney and thyroid problems. People who take these medications need to have an open, cooperative process with their prescribing physician; finding a drug or drug combination that both works and is tolerable is an important part of mental health treatment. When treatment is mandated by law, that just isn&rsquo;t possible. Assuming that a person is incompetent and that their perceptions are irrelevant will not make that person want to participate in mental health treatment.&nbsp;</p>

<p>Another extreme measure proposed by Harris in her plan: weakening privacy protections afforded by the Health Insurance Portability and Accountability Act, better known as HIPAA. Currently, medical professionals are not legally allowed to share people&rsquo;s treatment information without consent. Harris would allow health care providers to disregard the consent of their patients if they happen to think doing so is important.</p>

<p>Making rights provisional on the discretion of providers&rsquo; judgment will disproportionately impact women, young people, transgender people, and <a href="https://www.vice.com/en_us/article/qvedxd/doctors-dont-always-believe-you-when-youre-a-black-woman">people of color</a> and any permutations thereof &mdash; basically any of the people on the receiving end of well-documented health care disparities. Even the most well-intentioned doctors can make mistakes and are subject to bias. Privacy rights should not be a judgment call.&nbsp;</p>

<p>Allowing family members access to financial information would also gut privacy rights. Harris&rsquo;s plan calls for making medical financial information available to family members. A young trans man named Jack, who asked to be identified by only his first name for privacy reasons, explained how such a policy would have prevented him from medically transitioning and potentially put his life at risk.</p>

<p>&ldquo;Whether the reaction would be kicking me off the plan or kicking me out of the house, I don&rsquo;t know,&rdquo; he told Vox. But with the right to medical privacy, Jack was able to get the medical support that was needed. &ldquo;I have friends who would lose their homes, their college funding, and potentially come into harm if their parents found out about their medication,&rdquo; he said.</p>

<p>Leaders in the disability rights community have unequivocally condemned Harris&rsquo;s plan. On her personal Twitter account, Autistic Self Advocacy Network executive director Julia Bascom described the plan as &ldquo;the worst mental health platform I have read yet &hellip; This is a regressive and shameful proposal.&rdquo;&nbsp;</p>

<p>Jennifer Mathis, a leader in the mental health rights legal community, told Vox she has &ldquo;grave concerns about some of the plan&rsquo;s provisions.&rdquo; However, she ended her comment on an optimistic note: &ldquo;I hope that the campaign will work with the disability community to revise the plan to address these concerns.&rdquo;</p>

<p>With the disability community and activists pointing out the dangers in Harris&rsquo;s plan, I too hope that her campaign will consider the values and policy goals of the people she is ostensibly trying to help. The current plan envisions an America where forced drugging and locked wards are positioned as freedom for people with mental health conditions. It is not an America I would like to live in.</p>

<p><em>Sara Luterman is a Washington, DC-based freelance journalist and commentator. She writes about disability politics, research, and culture. Her work has appeared in the Washington Post, Slate, the New York Times, and Undark Magazine, among other outlets. Follow her on&nbsp;</em><a href="https://twitter.com/slooterman"><em>Twitter</em></a><em>.&nbsp;</em></p>
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