Today was the first full day of the Trump Administration. I’ve just arrived home from the NYC portion of the Women’s March, and as we all settle in for Day Two of our nation’s first ever post-modern Presidency, a few thoughts come to mind. We each have a moral obligation to oppose Donald Trump’s threat to democracy in the domains we know best, and for me, that’s disability policy.
As I discussed in Vox the day after the election, our goal for the next four years should be to make disability a big part of the progressive pushback against Trump – and in doing so, strengthen the ties between disability advocates and other progressive leaders to make sure we’re ready for what comes next. The Trump Presidency will be a disaster for people with disabilities – but with the right tactics, we may get the silver lining of finally bringing disability into the mainstream of the progressive coalition. So let’s get to work.
With that in mind, it’s worth thinking about how to read the tea leaves on what to expect from the Trump Administration on disability. We already know that Trump intends to block-grant Medicaid, repeal the Affordable Care Act, and utterly decimate the funding base for disability service-provision over the next several years. To a significant degree, that’s not personal – it’s just conservative orthodoxy.
To be clear, these policies represent a horrifying loss of critical consumer protections and hundreds of billions of dollars in funding for disability services. They are the most consequential issues for disability rights advocates – because their passage will put the lives of hundreds of thousands of Americans at risk. Still, most of those promoting ACA repeal or Medicaid block granting are doing so out of the GOP’s usual approach of right wing copy-paste legislating. The impact on people with disabilities is far from their mind or comprehension – and so we have to look elsewhere to discover the Trump Administration’s more considered intentions for disability policy-making.
Personnel is policy
The vast majority of policy-making doesn’t take place in the White House. The federal government is a massive place – over two and a half million people work for the executive branch (not counting military personnel) and any administration must produce countless thousands of pages of policy and regulation in any given year. No President could manage all of this on their own, even with their White House staff. The President must appoint several thousand political appointees to manage agencies outside the White House and implement an agenda on his behalf. Unlike civil servants, who stay regardless of who wins an election, political appointees leave when their President’s term runs out, if not before, and are replaced by the incoming President. These appointees receive some broad supervision from the White House, but are mostly left to their own devices when they don’t need to propose a new regulation or make a budget request.
And so, the first big sign we’ll get about how the Trump Administration intends to approach disability policy-making will come in their appointments to the federal government’s key disability policy positions. The Assistant Secretary of the Department of Education’s Office of Special Education and Rehabilitation Services, the Assistant Secretary of Labor for the Office of Disability Employment Policy and a small collection of about a half dozen other jobs will give us our first real sense of who Donald Trump intends to be on disability issues.
There is a significant possibility that the Trump Administration will appoint people to these positions in the same way that past Republican Administrations have. Typically, the President delegates filling political appointments to an Office of Presidential Personnel, tasked with filling and as-needed refilling the various political appointments that keep the government running. Republican Presidents usually fill disability appointments from the ranks of prior Republican administrations, legislative staff for GOP Members of Congress, state disability policymakers, the occasional conservative think tank figure and other members of the conservative ecosystem with an interest in disability of one type or another. These appointees range from the highly competent, knowledgeable and motivated (there are a few Bush and Reagan administration officials on disability I continue to have immense admiration for and work closely with) to the in-over-their-head hacks who have a personal connection to the President and needed to be stuck somewhere. And everything in between.
As filling appointments go, this would be the best case scenario under the Trump Administration. We’d likely get some disasters muddling their way through, some good people doing the best they can as the White House undercuts them by slashing budgets, and various twists on the same general theme. Disability rights advocates have a lot of experience working with Administrations staffed under these circumstances, and can make lemon from lemonade even with the less competent political appointees. Everyone has a learning curve – you make it work.
However, this is only the best case scenario. To understand the worst case, we need to take a step back and think about Trump’s only real statement on disability issues as a candidate. Politicians take a lot of flak for lying on the campaign trail, and in Trump’s case it is most deserved. But you can still learn a lot by seeing where a candidate’s mind goes instinctively when asked a question – sometimes, it reveals a rare area of genuine conviction.
In eighteen straight months of campaigning, Donald Trump’s only real statement on disability policy was his passionate defense of the discredited hypothesis that autism is caused by vaccinations. On multiple occasions on the campaign trail and during debates, Trump returned to this theme. Before and since the election, his campaign has interacted with prominent anti-vaccine advocates like Andrew Wakefield and Robert Kennedy Jr. As far as disability policy is concerned, autism anti-vaccine myths are the only thing that we know that Donald Trump has strong personal opinions regarding. And so, if Donald Trump decides to take a personal interest in his appointments to disability policy jobs, we know exactly who he’ll be listening to.
In the last several years, the “fringes” of autism advocacy have united together
This is much worse than it seems. One of the most interesting and concerning trends of the last eight years is the growing alliance between the autism anti-vaccine movement and the pro-institution developmental disability lobby. During the years of the Obama Administration, disability rights advocates scored a number of key victories around community inclusion in residential, day and employment services. Federal policy promoted bringing people with disabilities out of institutions and sheltered workshops and into integrated community living and supported employment settings. Needless to say, this sparked something of a backlash.
Throughout the 1980s and 1990s a vocal contingent of parent advocates affiliated with groups like Voice of the Retarded (VOR) and others agitated passionately against the closure of state institutions and the shifting of people with disabilities into the community. Some of these groups received substantial funding from public sector labor unions concerned that their members would lose their jobs if the state shifted residents out of institutions and into the community. However, in most cases, the families involved had excellent intentions yet were deeply misguided about the value of community living.
The research shows an overwhelming degree of support for the value of community living over institutional ones. In most cases, families who are worried or concerned about community living reconsider after their child enters the community and accesses adequate supports. For example, a comprehensive study of parental attitudes and outcomes to community inclusion around the closure of the famous Pennhurst institution in Pennsylvania saw a dramatic shift in parental opinion after their relatives entered the community. From 55% of families strongly opposing community placement prior to their relative leaving the institution, only 4% continued to do so after their relative had entered the community. The same study found that, while only 19% of families surveyed strongly agreed with community placement prior to relocation taking place, a full 66% strongly agreed with it afterwards.
The pro-institution lobby has always had a certain degree of relationship with the autism anti-vaccine movement. For example, a 1993 editorial from Bernie Rimland – founder of the Autism Research Institute and a prominent evangelist for anti-vaccine pseudoscience – warned parents to “Beware the Advo-Zealots” promoting community living for adults with developmental disabilities. But as de-institutionalization has progressed and the autism vaccine causation hypothesis has been conclusively discredited in the eyes of the public, these two “fringe” movements in disability advocacy have begun to come together.
Several years ago, VOR began collaborating closely with Age of Autism and other anti-vaccine groups, accurately recognizing that those who refuse to believe the overwhelming evidence on vaccine are unlikely to believe the equally overwhelming evidence in support of community living. The relationship is close and ongoing, with VOR and other similar parent groups successfully enlisting anti-vaccine parents in efforts to oppose shifts away from sheltered workshops, the expansion of rights for individuals living in group homes and other restrictive service-provision environments and further efforts to shift state and federal funds away from institutional care and towards community supports. As a result, there are rapidly expanding social, professional and financial relationships between anti-vaccine and pro-institution advocates. While anti-vaccine parents continue to hold a variety of views around inclusion in residential, educational, day and employment settings, there is an increasing likelihood that the leaders of the anti-vaccine movement will have considerable sympathy for pro-institution policy-making preferences.
A Trump Administration that believes that vaccines cause autism insults Autistic people and can do tremendous harm to public health. But at the end of the day, defending vaccine policy is not a core interest of disability rights advocates. There are others for that job, and compared to other areas Trump is engaged in, it is not even a top five concern.
But once we take into account the “congealing of the fringe” that’s taken place in autism and developmental disability politics over the last decade, an anti-vaccine President is a much scarier prospect. After all, the people that have Trump’s ear on disability aren’t just anti-vaccine – they also hold views that promise to reverse decades of federal policy promoting inclusion and access to the community for people with disabilities.
If Donald Trump turns to his anti-vaccine friends to fill disability policy positions within his Administration, he will be getting names prepared to reverse the most cherished victories of disability advocates around closing institutions, expanding community services, shifting people out of sheltered workshops into integrated employment and expanding choice and control people with disabilities have over their own lives.
So watch the appointments carefully, and be prepared to respond. For some positions, a Senate confirmation process exists that will afford an opportunity to investigate the views and qualifications of Trump’s nominees. I can speak from personal experience that the anti-vaccine and pro-institution wings of the autism and disability worlds are not reluctant to use this process to advocate against nominees who don’t match their views (as is their right). We would benefit from following their example.
For other positions, no Senate confirmation requirement exists – meaning that disability advocates will need to make their case to the press and the public in order to sound the alarm bells as quickly as possible. Highlighting the ways in which pro-institution political appointees may threaten to reverse hard-won Obama Administration victories on disability rights may help limit the damage – or at least educate progressive advocates from other communities about these issues. That education may matter quite a bit when the next Democratic President gets inaugurated (swiftly, and within our days).
It is my sincere hope that this speculation all proves unnecessary. If we’re fortunate, the first round of Trump disability appointees will show us their personnel policy on disability is similar to Bush and Reagan before him. But if we’re not, it will be more important than ever for the disability rights community to be ready. When it comes to community living, Donald Trump can be as dangerous for people with disabilities as he is for so many other parts of the country.