This document highlights the significant healthcare challenges faced by people with disabilities. It details how barriers such as poverty, limited employment opportunities, inadequate healthcare access, and underfunded special education systems contribute to persistent inequities. Three roundtable discussions with people with disabilities and advocates led to policy recommendations focused on expanding services, removing financial disincentives, and increasing support for inclusive healthcare and education.
One in four Americans report having a disability. People with disabilities are more likely to be poor, especially in rural areas. In 2019, nearly half (46%) of people with disabilities lived in households with financial hardship. This report focuses on health care and how universal healthcare can address the unique barriers for people with disabilities.
Health Care Outcomes and Disabilities
People with disabilities already face complex barriers in existing US healthcare systems, which include both private insurance and public programs like Medicaid and Medicare. Based on information on health outcomes for people with disabilities, they are at a significant disadvantage.
- Life Expectancy: Some people with disabilities die up to 20 years earlier than those without disabilities. In specific cases, like intellectual disabilities (ID), the risk of premature death is twice as high.
- Chronic Conditions: People with disabilities have twice the risk of developing conditions such as depression and poor mental health; asthma, diabetes, and heart disease; obesity; stroke, and poor oral health.
- Maternal Health: Pregnant women with disabilities face an 11 times higher risk of maternal death and significantly higher rates of severe birth-related complications.
- Preventive Care: Individuals with disabilities are less likely to receive routine screenings like mammograms, Pap tests, or dental care.
The barriers that create these poor outcomes are systemic. Eligibility systems are difficult and cumbersome, and make it more denial-based than seeking those in need of services. In the state of Indiana, for example, Medicaid is not allowed to advertise the availability of its services to the public. Many of the following were mentioned by the roundtable and confirmed by reports from the World Health Organization.
- Legal and regulatory: Laws and policies that may deny individuals the right to make their own health decisions.
- Inadequate insurance coverage: Coverage gaps are common, often excluding critical services such as prescription drugs, rehabilitation therapies, dental care, and assistive technology.
- Institutional bias: Some programs may favor funding care in institutional settings over a person’s home or community, limiting individual choice.
- Physical and communication barriers: Many healthcare facilities lack accessible equipment and effective communication aids. Healthcare providers may also lack training in communicating with and accommodating patients with disabilities.
- Discrimination and bias: People with disabilities report discrimination and negative attitudes from healthcare providers, which can result in denial of care or worse health outcomes.
- Transportation: creates a barrier to getting to appointments. If the person does not have help, they may miss appointments or fail to schedule. And some disabilities, like attention deficit disorders, can interfere with a person’s ability to schedule needed appointments.
- Lack of advocacy: Not everyone is good at advocacy, and some may not be as comfortable pushing health care providers.
- Trauma: Some people have had trauma accessing health care, so they may be fearful of medical services.
- Inadequate emergency services follow up: Individuals with disabilities are often treated at the ER and don’t have good follow up or regular and comprehensive care.
- Lack of mental health services: There are fewer mental health providers in the country, and not many incentives for providing those services.
The Solution – “Nothing About Us Without Us”
Universal health care (UHC) will benefit people with disabilities significantly by removing financial barriers, expanding access to essential services, and ensuring comprehensive coverage for their unique needs, including specialized care, rehabilitation, and assistive devices. For UHC to truly be universal, it must be disability-inclusive, meaning it requires the active participation of people with disabilities in policy design, accessible information, and the removal of both physical and systemic barriers within the healthcare system. Laws like the Affordable Care Act (ACA) have helped expand coverage for people with disabilities by reducing cost-related barriers, though challenges remain in achieving full equity and comprehensive care.
Investing in universal health care (UHC) and disability-inclusive health systems provides significant economic returns, with studies as of 2026 showing returns ranging from $1.40 to $10.00 for every $1.00 spent. For individuals with disabilities, specific investments in assistive technology (AT) can yield a 9:1 return on investment (ROI) by unlocking lifetime earning potential and increasing societal participation.
ROI of Universal Health Care (UHC)
Universal healthcare systems are projected to generate substantial savings and economic growth by improving workforce health and reducing administrative waste.
- Economic Dividends: The World Health Organization estimates a market-valued return of $1.40 for every $1.00 invested in UHC, which can rise to $9.00 when considering the intrinsic value of human life.
- Systemic Savings: A universal single-payer system in the U.S. could lead to a 13% savings in national healthcare expenditure, equivalent to over $450 billion annually.
- Labor Supply: Expanding coverage increases the labor supply by reducing absenteeism and disability, potentially increasing net economic well-being by roughly $100 billion a year.
ROI for Disability Inclusion & Assistive Technology
Targeted investments in disability-inclusive healthcare and workplace support drive high economic and social returns.
- Assistive Technology (AT): Sustained provision of items like hearing aids, prostheses, and wheelchairs generates an ROI of 9:1. Global provision of AT is estimated to yield more than $10 trillion in economic benefits over the next 55 years.
- Inclusive Prevention: Investing in UHC for persons with disabilities, particularly to prevent noncommunicable diseases, can deliver a $10 return for every $1 spent.
- Vocational Support: Inclusive apprenticeship and vocational programs can yield roughly $1.44 in benefits for every $1.00 spent due to higher productivity and lower turnover.
- GDP Impact: Countries are estimated to lose approximately 7% of their GDP when persons with disabilities are excluded from the labor market.
Disability Policy Recommendations
Disability is the one minority that anyone can join at any time. all of us are a fall, an automobile accident, or other mishap away from becoming disabled. Health insurance designed with people with disabilities in mind will benefit everyone. Just like universal design benefits all.
Barriers to health care access contribute to a cycle of health inequities, with people with disabilities being significantly less likely to receive preventative screenings for cancer, dental checkups, or regular eye exams. Addressing these challenges requires a systemic approach, including better provider education, universal design in facilities, and policies that ensure equitable insurance coverage.
The policy recommendations from the disabilities roundtables call for expanding home and community-based services, removing financial disincentives such as asset and marriage penalties, and making healthcare—including dental, vision, mental health, and telehealth—more accessible and inclusive for people with disabilities. They also advocate for restructuring employment and benefits systems to eliminate income eligibility cliffs, improving transportation, and supporting innovations like autonomous vehicles.
All of this requires a health care system that emphasizes individualized care; supports people to reduce reliance on specialized services while maintaining eligibility, and rewarding providers for health improvement not illness. Building universal health care to serve everyone will benefit all communities.