A Real Disability Issue, But Is Anyone Listening? The Seventh Republican Presidential Debate

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Andrew Pulrang

Let’s take a moment and give due credit to John Kasich.

Unless something very weird happens in the next several months, he’s not going to be the next President of the United States. But Governor Kasich is the only candidate of either party so far in this cycle to bring up a bona fide, not accidental, not quippy-insulting disability issue in a televised debate. He’s done it twice now.

Last Thursday night, in a rather loosely-related response to a question about how his religious faith might affect his politics, Kasich once again touted some kind of Medicaid adjustments he made in Ohio that, somehow, resulted in “Mom and Dad” being able to stay in their own homes instead of going into nursing homes.

While the exact policy details are still unclear to me, the concept should be familiar to millions of Americans with aging parents, and millions more who have significant physical disabilities. Whether Kasich fully understands the issue itself, he is referring to the fact that it is both cheaper, on average, and better by far if people who need long term care are able to get it in their own homes, rather than having to be institutionalized in a nursing home or other “facility.” He mentioned this same thing in the last Republican debate, claiming credit for what seems like the very kind of progress disability activists want to see. In fact, he used almost exactly the same words, though this time he didn’t mention having “taken on” the nursing home lobby.

It was remarkable to hear one of our most important and difficult disability issues mentioned in a televised debate by a candidate. It was just as remarkable, if not more, to hear it brought up again, in another debate.

What does this mean? Several things, I think.

Given Kasich’s minimal chances of winning the Republican nomination, it doesn’t really tell us how the next President will handle the issue, because that probably won’t be Gov. Kasich. If we do make it much easier than it is now for disabled people, including the elderly, to stay out of nursing homes, we will still have to grind out those gains the hard way, bit by bit, bill by bill.

Justifiably or not, this is a piece of his record as Governor that Kasich is proud of. He’s proud enough of it to mention it twice to an audience made up mostly of people who haven’t a clue about disability issues. That suggests at least the possibility that this issue might someday show up on more politicians and voters’ radar screens.

Kasich sees the issue … or speaks of it anyway … as a healthcare issue and an aging issue, not a disability issue. That’s unfortunate, but probably doesn’t matter too much.

Twice a disability issue has been mentioned as an area where, theoretically, lowering the cost of an entitlement can go hand in hand with better services recipients actually prefer.

Gov. Kasich has come up with a two or three sentence way to describe the home care vs. nursing home issue to a general audience. It doesn’t seem like an especially effective description, but it’s a start/

Based on the lack of curiosity from the moderators, the press, or the other candidates, this issue hasn’t come close to catching fire, except maybe with Kasich himself and the disability policy and activist community. As a matter of fact, the disability community doesn’t seem all that impressed either, or to have even noticed.

This is one of the toughest problems with the issue itself.

It should resonate powerfully, and not just with the disability community. But it takes too long to explain the connection between the parallels and differences between home care and nursing homes. It takes too long describe why people go into nursing homes when they don’t really want to, and how outdated regulations and funding mechanisms stand in the way of disabled people living fuller lives. It’s too complicated to refer to with a neat slogan, and it’s too subtle to raise the passions of ordinary voters who aren’t personally connected to the issue.

I suspect most viewers have no idea what Kasich is talking about. Worse, nobody seems to be curious.

It’s one of the risks of trying to address disability issues in televised debates.

It’s the same problem many of the Republican candidates seem to have whenever they try to discuss policies or explain complex positions … anything really beyond fear, grievance, or angry nationalism. That was on full display, too, during Thursday’s debate. Every now and then, a candidate tried to talk in detail about some topic, not just bluster about it. But these efforts to be reasonable generally fell flat and went unnoticed.

Rhetoric matters, though, and so do even underdeveloped ideas. Governor Kasich has twice mentioned an issue that matters to the disability community, and even if that’s all that he accomplishes … even if his record isn’t as great as he says it is … he’s done a service to bring it up.

Stray observations:

– Jeb Bush criticized Trump … who wasn’t there as you must have heard … for “making fun of disabled people.”

– Jeb Bush was asked to comment on reports of corruption at the Wounded Warriors Project. Both Bush and Ben Carson briefly mentioned the idea of charity oversight, but gave no details and quickly pivoted to other things they preferred to talk about.

– The Fox News moderators asked about entitlement reform, traditionally a favorite Republican topic. Christie completely ignored the opening to score a hit on Planned Parenthood. Cruz said he would “repeal every word” of Obamacare, but also that he would “delink” health insurance from employment. “Delink” means in some way making it so nobody actually has to depend on getting health insurance through a job. This is an interesting idea normally heard from liberal Democrats and health care policy wonks. It’s hard to say how the idea fits into Cruz’s overall vision, but it’s interesting.

– The exciting outsider vs. level-headed insider conflict is as active in the Republican party as it seems to be with the Democrats.

Next debate: Republican, February 6, 2016.

Contact: Andrew Pulrang