Disability does not care about your party affiliation. Neither do I. My job requires me to work with coalition partners and legislators across the political spectrum to protect the legal rights of people with disabilities. I do this because people with disabilities, and their allies, are everywhere.

The most important thing I have learned from working with our partners on the right is the importance of data. Cost-benefit analysis is key in evaluating any public investment. Conservatives sometimes get labeled “heartless” for focusing on the bottom line, but, at the end of the day, they care deeply about the fiscal impact of any program. They do this not in spite of the impact on people, but because of it.


Understandably then, the House and Senate healthcare bills focus on cutting costs. For instance, both bills would alter Medicaid funding in a way that significantly reduces funding for “optional” Medicaid programs. That includes Home and Community Based Services (HCBS).

HCBS keep people with mental illness, Intellectual & Developmental Disabilities (I/DD), and traumatic brain injury (TBI) — including members of our state’s sizable veteran population — in their communities and out of institutions. The data has shown over, and over, and over again that HCBS are one of the most fiscally effective parts of Medicaid. They are two to 30 times less expensive than comparable institutional placement. And they produce better results.

By keeping people in their communities, HCBS also promote independence and self-reliance. People who stay in their communities contribute to their communities. They live fuller, freer, more productive lives. They are more likely to get and maintain employment, and pay taxes as a result. Without access to HCBS, more Americans will face a life of purgatory in costly state-managed institutions — where the government can decide where you will live, when you eat, and what you do in your spare time.

With soaring healthcare costs, we absolutely need to rein in spending where it is wasteful. But why are we trying to pass healthcare legislation that would gut the most fiscally effective parts of Medicaid?

Some believe that the government should have absolutely no part in providing healthcare to anyone. As an ideological position I see where those people are coming from. But even if Medicaid were to go away today, people with significant disabilities would not.

Without Medicaid, more Americans will go into crisis more often and cycle in and out of those costly state-managed institutions — and our criminal justice system. The fallout from their unmet needs would put additional, significant strains on our schools, police, courts, and hospital emergency departments. Those unavoidable costs would still fall on taxpayers and balloon to astronomical levels over time.

We, as a country, are going to have to spend money on Americans with significant disabilities, whether we want to or not. It also doesn’t take a bleeding-heart liberal to say that one of the pacts we make as Americans is this: being born with autism, or Down Syndrome, or cerebral palsy, or a brain disorder — or getting wounded while honorably serving this country — should never mean the death of your right to liberty and basic dignity. If that is the commitment we are going to make as Americans, then we should be maximizing people’s independence by spending money smartly, where it counts. That means preserving HCBS and no longer defaulting to taxpayer-funded institutionalization of Americans with significant disabilities.

Effective healthcare reform is possible. It requires us to be shrewd about how we spend our money. “Medicaid” may be a dirty word for many of my conservative friends. But for us to get right on healthcare reform, our focus needs to be on the cost-benefit analysis, first and foremost. That means saving the parts of Medicaid that work.

Matthew Herr is an attorney and policy analyst with Disability Rights NC. Follow him on Twitter at @MattHerrTweets.

The views expressed by contributors are their own and are not the views of The Hill.

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The conservative case for saving Medicaid