For sixty years, I’ve been reporting on the disabled and disability rights groups. In school systems like NewYork’s, kids “with special needs” (an administrative euphemism) are left far behind, along with English language-learners. In the nation’s continually overflowing prisons, the disabled serve heavily intensified sentences.
My interest in this dark side of the Fourth Amendment’s equal protection under law was quickened long ago when a member of the disability rights group Not Dead Yet was driving me to a protest meeting. Turning to me as we arrived, he told me, “Like many Americans, you’re only temporarily able.” Now eight-seven and a half, I remembered that as arthritis took over my leg. I look with envy from my window at all those passersby for whom walking is as natural as breathing.
From an entirely unexpected source, President Obama’s Affordable Care Act, I have recently come across a community-based approach to expanding and deepening individualized care of the disabled. As reported by Michelle Diament (“Feds Begin Rollout of Community Living Program,” disabilityscoop.com/2012/09/05): “The Centers for Medicare and Medicaid Services said on September 5 that California will be the first state to participate in the Community First Choice Option” by which what I still call Obamacare “offers states more Medicaid dollars for community living in exchange for agreeing to eliminate caps on the number served in the community.”
My primary, fierce objection to Obamacare was its establishment of a powerful final commission whose members—without examining any patient—thoroughly interfered with the doctor-patient relationship by deciding to end a treatment if a doctor’s treatment cost too much in federal funds. But I welcome the early stages of what Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services, describes: “Thanks to the Affordable Care Act, seniors and persons with disabilities in California will have better options that will help them get the care they need in their own homes and communities rather than institutions like a nursing home.”
This is how the Community First Choice Option works, Diament reports: “States can qualify for a 6-percentage-point bump in funding to provide attendant services and supports in the community for Medicaid beneficiaries who would otherwise require care in institutions. People with disabilities who are served under the program must receive supports in accordance with their preferences under a so-called ‘person-centered plan.’”
Obviously, 6 percent is speculative, for openers, and as Thomas Jefferson once said, “What the government gives, the government can take away.” Further, I don’t trust the media to be reporting the progress of Community First Choice Option accurately, since, as of this writing, there has been very scant public notice of this unprecedented governmental focus on so individualized an approach.
However, I do expect that continuing and close attention to this development will be paid by disability-rights groups and indeed by many of the disabled–as well at least some reporters who may newly realize that they are only temporarily able. I’m going to stay on the story.
Significantly, Michelle Diament continues: “For California, committing to the initiative will mean an added $258 million in the first year alone.” But dig this: “The extra funds will continue for as long as the state elects to remain in the program,” a CMS official said. A deficit-slashing governor and legislature could summarily depersonalize this support of the state’s disabled.
One disability-rights group that I expect will maintain very close scrutiny of California’s record on the Community First Choice Option is ADAPT, an early leader in the fight for wheelchair lifts on public transit. Says Bruce Darling, a member of ADAPT: “To see the first state eliminate the institutional bias and know that others are in the pipeline is an amazing feeling. I look forward to the day when community living is so much the norm that people will look back thinking they couldn’t imagine it any other way, much the same way that young folks look at me in disbelief when I say we used to fight to put lifts on buses.” (Surely other members of ADAPT recognize that battles still continue around the country over lifts on buses and other person-centered adjustments to taxis and facilities in public housing and the like.)
A selling point for disability rights groups elsewhere is that Community First Choice does save public money. Christine Vesta wrote enticingly about this new law: “It is well known that nearly all seniors (as well as) adults with disabilities want to remain in their homes as long as possible and it’s vastly cheaper to states to provide the help—meals, bathing and dressing, and other home services—that allows them to do so without resort to institutionalization.
“Yet the majority of those who need long-term care are isolated in facilities estimated to cost at least three times as much as comparable home-based care” (“Defending Our Freedom,” 2010blogspot.com, April 17, 2010).
Conceivably, as decent care for the disabled begins to cost governments less, there may even be bipartisan backing of the Community First Choice Option.
Nat Hentoff is a Universal (UClick) syndicated columnist, a senior fellow at the Cato Institute, and the author of, among other books, Living the Bill of Rights (University of California Press, 1999) and The War on the Bill of Rights and the Gathering Resistance (Seven Stories Press, 2004). His latest book is At the Jazz Band Ball: Sixty Years on the Jazz Scene (University of California Press, 2010). He is currently working on his next book, Is This Still America?