More than two decades after the passage of the Americans with Disabilities Act (1990), people with disabilities continue to live at the margins of American democracy and capitalist society. This persistent exclusion poses a conundrum to political theorists committed to disability rights, multiculturalism, and social justice. Drawing from feminist insights, specifically the work of Nancy Fraser, among others, I examine the necessary conditions for meaningful inclusion to be realized within a deliberative democracy. Using Fraser's concept of “participatory parity” as a proxy for inclusion, I strategize how to overcome informal barriers—economic inequality and misrecognition—that persist even after disabled people are granted the legal right to participate. The analysis concludes that a truly inclusionary and multicultural democracy requires the redistribution of wealth and a more expansive model of political deliberation, one that can recognize unconventional (even nonverbal) modes of communication through practices of translation.
Deinstitutionalization heavily implicates Medicaid policy since waivers for home and community-based services have provided the means to realize the community integration mandate of the Americans with Disabilities Act (1990) and the Supreme Court's Olmstead (1999) decision. Despite tremendous advances toward community living, several components of Medicaid's design and implementation continue to create barriers for people with disabilities who want to live independently in the community. This article draws on knowledge produced from the lived experience of disability to identify five issues with Medicaid policy that prevent it from living up to the promise of the ADA and the Olmstead ruling: (1) institutional bias, (2) federalist structure, (3) work disincentives, (4) red tape and administrative burden, and (5) low reimbursement rates for personal care attendants. The wider implication of the analysis is that deinstitutionalization involves more simply closing institutions. Active measures to promote community integration are also vital.
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