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Potential Voters with Disabilities Face Important Choices

Copyright 2004 by Laura Hershey

If you are one of the more than 35 million Americans with disabilities aged 18 or older, or if you care about the rights of people with disabilities for any reason, you have some crucial decisions to make this year.

Will you register to vote? Or will you sit passively by, hoping others can make wiser decisions than you can?

Will you demand that candidates take informed and principled positions on disability issues? Or will you be intimidated into thinking these are minor, "special-interest" concerns?

Will you actually go to the polls and vote -- both in your state's primary, and in the general election in November? Or will you abdicate that awesome responsibility?

And finally, you are faced with another decision: Will you allow President Bush to serve the corporate nursing home industry for another four years? Or will you fight back, using your vote to support freedom and independence?

George W. Bush "won" the presidency in 2000 partly because too many people with disabilities neglected to vote. That year, a survey of Americans with disabilities conducted by the National Organization on Disability and the Louis Harris Organization found that only 62 percent of disabled people were registered to vote, compared with 78 percent of nondisabled people. In the 2000 presidential election, only 41 percent of voting-age Americans with disabilities voted, compared with 51 percent of all voting-age Americans. Of those disabled people who did go to the polls, a majority -- 56 percent -- voted for Al Gore. Only 38 percent voted for Bush. The survey concluded that if disabled Americans had voted at the same rate as other Americans -- that is, if 51 percent of us had voted, instead of only 41 percent -- Gore would have won the election.

Even Bush recognized that he could benefit from gaining more support from a group as large and significant as the disability community. So during his 2000 presidential campaign, he made promises to try to win us over. Early in his administration, President Bush announced his "New Freedom Initiative" for Americans with Disabilities. Among his promises, he vowed to support more independent living options for people with significant disabilities. Last year, the President announced his support for the so-called "Money Following the Individual Rebalancing Initiative," which would redirect Medicaid funds to support people who preferred living in the community.

By trumpeting his commitment to changing Medicaid policies which force people with disabilities and older people into nursing homes and other institutions, Bush gained some points with the disability community. The U.S. Medicaid program has long been criticized for disability advocates for its unfair and expensive "institutional bias," policies which guarantee payment for nursing home placement, but which leave many home-care programs impoverished and inadequate. As a result of this bias, disabled people who need help with their daily activities such as dressing, bathing, and eating often find that they can no longer manage to live in their communities, because the help they need is unavailable. Instead they must relocate to nursing homes, giving up their independence, their privacy, and their most basic human and civil rights.

Now, President Bush has backed away from this commitment. His recently-unveiled budget for fiscal year 2005 has no funding for Money Following the Individual Rebalancing Initiative. The $1.75 billion that was in the proposed 2004 budget has been reduced by 70%, to only $500 million each for fiscal years 2006-2009. This represents a major pullback from the President's earlier rhetoric about a major commitment to changing the institutional bias.

"Money Follows the Person" policies represent real justice -- the idea that no one should be imprisoned in a nursing home, when the same dollars could support them in their own home instead. Why would Bush change his mind about supporting such a sensible, humane policy change? And why wouldn't Congress demand such reforms? We might answer those questions by saying, "The votes follow the money."

During the 2004 election cycle, the hospital/nursing home industry ranks 24th among all industries and terms of the amounts of campaign contributions. Combined, individuals and PACs representing that industry have donated a total of $3,656,029. Of that total, 60 percent ($2,209,829) have gone to Republican candidates, and 39 percent ($1,441,375) to Democrats.

(Lest we assume that either party is pure, however, the historical data shows otherwise. When the Democratic Party occupied the White House and dominated Congress, Democrats were the major beneficiaries of the hospital/nursing home industry's largess. In 1994, 60 percent of hospital/nursing home donations went to Democratic campaigns, and only 39 percent went to Republicans. The overall totals for the period from 1990 to 2004 are about evenly split, with 51 percent of contributions going to Democrats, and 49 percent going to Republicans.)

But back to 2004. The second most generous contributor is the American Health Care Association (AHCA), the nursing home industry's powerful lobbying group. AHCA has given $241,610 -- 58 percent of that to Republican candidates, and 42 percent to Democrats. Several national nursing home corporations have also made hefty contributions. Manor Care Inc. has contributed $89,555, and has made its political biases much more obvious; 96 percent of Manor Care's gifts have supported Republican candidates, while only four percent have benefited Democrats. Kindred Healthcare has given $40,000 -- 73 percent to Republicans, and 28 percent to Democrats.

President George W. Bush has received by far the most money from the hospital/nursing home industry -- a total of $563,545. Among the Democratic candidates, Howard Dean has received $101,190. (Not surprising, since he is a physician and probably sympathetic to the medical profession's policy agenda.) John Kerry has received $79,350. John Edwards, on the other hand, has received only $32,600 from this industry, perhaps a reflection of his background as a personal-injury lawyer.

(All of this data is from research conducted by the Center for Responsive Politics.)

So what will your choice be? Vote, as the late great Justin Dart urged, "as if your life depended on it -- because it does!"? Or let nursing home corporations and other powerful groups buy this year's election?

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