How Health-Care Reform Could Improve Employment Prospects for People With Disabilities


As job growth remains persistently sluggish, women and men with disabilities are among those who face the toughest employment challenges. And in attempting to reverse these trends, some disability rights groups are looking to the promise of job creation under the Affordable Care Act (ACA) as a solution.

The current unemployment rate for women with disabilities in the United States is 15.8 percent—more than double that of women without disabilities. Similar trends hold true for men with disabilities. Related to this, poverty rates for persons with disabilities are also disproportionately high.

“The saying ‘last hired, first fired’ is unfortunately very true for many people with disabilities,” Sarah Triano, executive officer of the California Committee on Employment of People with Disabilities (CCEPD), told RH Reality Check. “Right now, as people are slowly beginning to get jobs again, people with disabilities still are not.”

October is National Disability Employment Awareness Month, and in response to the troubling national employment statistics, state and federal policymakers have for some time been working on ways to improve employment prospects for persons with disabilities. The National Governors Association (NGA) released a report just last month guiding governors on the severity of the problem and how they may take actions within their state to reverse these employment trends. South Carolina and Connecticut, for example, have recently worked with Walgreens and other retail companies to develop a plan to hire more people with disabilities.

But retail jobs often do not pay very well or offer health insurance—realities of the current economy that could leave many persons with disabilities in tough economic situations. Thus some groups are encouraging employment of people with disabilities in better-paying health-care positions. And among its many effects, health-care reform is expected to increase the number of available jobs in health care.

As part of the ACA, the Obama administration launched the Health Care Innovation Challenge, a program that awards grants to those with compelling ideas about how to deliver health care. The program could increase the number of “mid-level” health-care workers, such as nurse practitioners, community health-care workers, and nurse-midwives.

But beyond improving employment statistics, there are far deeper reasons for persons with disabilities to pursue jobs in the health-care sector. A longstanding injustice many people with disabilities face is the way in which the medical world views them.

“The medical model of disability sees people with disabilities as objects to be cured or fixed, that they’re not natural,” Triano said. “Whereas a more social or political model takes a view that disability is a natural part of human diversity, and that instead what needs to be fixed is not the person, but the societal discrimination she faces.”

The National Organization of Nurses with Disabilities (NOND), a group founded and governed by nurses with disabilities, is among the advocates who are working to build a pipeline of persons with disabilities to fill health-care positions. In August, NOND signed on to an agreement with the U.S. Department of Labor’s Office of Disability Employment Policy expressing support for the hiring of persons with disabilities in the health-care industry—an agreement that can give NOND clout as they organize.

Through increasing the number of people with disabilities in health-care positions, CCEPD, NOND, and other groups aim to transform the medical model, thereby improving employment while also applying the social and political approach to meeting the needs of persons with disabilities.

“Disability advocates have worked hard for equality in transportation, education, employment, recreation, and other realms, but health care is one of the last domains for advocacy,” said NOND president Beth Marks. “And there is great power to transform the medical model within health-care settings. If you have daughter who uses wheelchair, and that child’s health professional wheels into the room, you’ve just in that one moment transformed that kid’s life.”

However, improving employment of people with disabilities in health care or any sector also requires major policy shifts as well as breaking barriers in many places of employment.

Currently, to qualify for disability in the United States, the Social Security Act (SSA) requires a person be completely unable to work. As a result, some people with disabilities who are eligible for benefits feel compelled to rely on the support to survive rather than pursuing work in a job market that is not friendly to them—even if they prefer to work.

As scholar H. Stephen Kaye of the University of California at San Francisco found,

Despite a widespread belief that government disability benefits provide an adequate safety net for working age adults with disabilities—perhaps even an enticement to leave the labor force when times are tough—the very high rate of unemployment following job loss indicates that a large proportion of those losing jobs either need to remain in the labor force or choose to do so.

Though it provides essential benefits for many, the SSA’s definition of disability—like the medical field—is perhaps also a model that can marginalize some people with disabilities who need or prefer to be employed.

To fight this policy model and to build the pipeline of persons with disabilities for health-care positions, workplace discrimination should also be addressed more fully. Nursing is currently an occupation with a high forecasted growth rate nationally and in California, and is also dominated by women. Yet nursing schools and employers are still reluctant to accommodate nurses with disabilities.

“Despite the potential for students with disabilities to enrich the nursing profession, nurse educators may be perpetuating historical attitudes, values, and practices that exclude students with disabilities from gaining admission,” Marks wrote in a journal article earlier this year.

Professionals with disabilities who now lead advocacy groups like NOND and CCEPD represent stories of triumph in the face of tremendous challenges presented by schools and employers’ refusal to accommodate them over the course of their careers. Triano, 39 and now a leader in the disability rights community, spent much of her life experiencing such barriers to education and employment. Triano has a hereditary immune system disorder, and she also identifies as a person with mental health disabilities. “I graduated from UC Santa Barbara, Phi Beta Kappa and valedictorian, and I wanted to go to law school,” she said.

But when she was applying to law school, the Law School Admissions Council would not accommodate her need for more frequent bathroom breaks while taking the Law School Admissions Test. “So I decided I didn’t want to go to law school, as I knew I was going to get stuck fighting for accommodations in law school, for the bar exam, and so on.”

Triano then began a PhD program in disability studies, but she was denied health insurance for her preexisting conditions. She was forced to drop out of school, and accept a position at an independent living center so that she could have health insurance coverage and a paycheck.

She worked her way up in the disability advocacy community and now leads the CCEPD, after she was appointed in May by Gov. Jerry Brown.

“It’s been a long journey,” she said.

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