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Saturday, December 15, 2018

Mandates and Out-of-Pocket Spending

The Politics of Autism includes an extensive discussion of insurance.

Molly K. Candon and colleagues have an article at Pediatrics titled "Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder." The abstract:
BACKGROUND: The health care costs associated with treating autism spectrum disorder (ASD) in children can be substantial. State-level mandates that require insurers to cover ASD-specific services may lessen the financial burden families face by shifting health care spending to insurers.

METHODS: We estimated the effects of ASD mandates on out-of-pocket spending, insurer spending, and the share of total spending paid out of pocket for ASD-specific services. We used administrative claims data from 2008 to 2012 from 3 commercial insurers, and took a difference-in-differences approach in which children who were subject to mandates were compared with children who were not. Because mandates have heterogeneous effects based on the extent of children’s service use, we performed subsample analyses by calculating quintiles based on average monthly total spending on ASD-specific services. The sample included 106 977 children with ASD across 50 states.

RESULTS: Mandates increased out-of-pocket spending but decreased the share of spending paid out of pocket for ASD-specific services on average. The effects were driven largely by children in the highest-spending quintile, who experienced an average increase of $35 per month in out-of-pocket spending (P < .001) and a 4 percentage point decline in the share of spending paid out of pocket (P < .001).

CONCLUSIONS: ASD mandates shifted health care spending for ASD-specific services from families to insurers. However, families in the highest-spending quintile still spent an average of >$200 per month out of pocket on these services. To help ease their financial burden, policies in which children with higher service use are targeted may be warranted.

Friday, December 14, 2018

Pushback Against Reckless Congressman

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Natalie Allison at the Nashville Tennessean
A day after U.S. Rep.-elect Mark Green drew national attention for his remarks suggesting a possible link between vaccines and autism, another Tennessee Republican in Washington took a stand for the public health benefits of vaccinations.
"Vaccines take deadly, awful, ravaging diseases from horror to history," U.S. Sen. Lamar Alexander tweeted Thursday.

The senator's remarks were followed by a terse 30-word statement from the Tennessee Department of Health later in the day Thursday, beginning with the phrase "Vaccines do not cause autism."
Alexander, who chairs the Senate Health, Education, Labor and Pensions Committee, tweeted a quote from a video he shared of him previously speaking about vaccines in the committee.
"Sound science is this," Alexander said in the committee meeting. "Vaccines save lives. They save the lives of people that are vaccinated. They protect the lives of the vulnerable around them, like infants and those who are ill."
Green, a Republican state senator from Clarksville who is also a physician, will be sworn-in to the U.S. House of Representatives, his first term, Jan. 3.

Tennessee Department of Health Statement on Immunizations Thursday, December 13, 2018 | 04:29pm NASHVILLE – Vaccines do not cause autism. Vaccines save lives. The Tennessee Department of Health welcomes discussion with Tennessee clinicians and scientists who would like to examine the evidence on this topic. ###

Thursday, December 13, 2018

Disgrace: Congressman-Elect Pushes Autism-Vaccine Notion

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Natalie Allison reports at The Nashville Tennessean:
A soon-to-be congressman from Tennessee told constituents Tuesday he believed vaccines may be causing autism, questioning data from the Centers for Disease Control and other institutions disproving such a theory.
Not only did Republican Mark Green, a Congressman-elect from Clarksville who is also a medical doctor, express hesitation about the CDC's stance on vaccines, he also said he believed the federal health agency has "fraudulently managed" the data.
His remarks came in response to an audience question at a town hall meeting in Franklin from a woman identifying herself as the parent of a young adult with autism. The woman was concerned about possible cuts to Medicaid funding.
"Let me say this about autism," Green said. "I have committed to people in my community, up in Montgomery County, to stand on the CDC’s desk and get the real data on vaccines. Because there is some concern that the rise in autism is the result of the preservatives that are in our vaccines.

Felicia Sonmez at WP:
Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, said that it was shocking that a newly elected congressman “would openly espouse such blatant antiscience and discredited views.”
“The science is clear: Vaccines do not cause autism or the other things the antivaccine lobby alleges,” said Hotez, whose recent book, “Vaccines Did Not Cause Rachel’s Autism,” draws on his experience as a vaccine expert and the father of an autistic child.
He added that without Green’s “immediate reaction and heartfelt apology, he deserves censure or exclusion.”
A spokesman for Green did not respond to a request for clarification of the congressman-elect’s claim that the CDC’s data may have been “fraudulently managed.”
Green was recently elected president of the Republican freshman class. He last year withdrew as President Trump’s nominee for Army secretary amid criticism of his past comments about Islam, evolution and LGBT issues.

Wednesday, December 12, 2018

Protesting Restraint

In The Politics of Autismdiscuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

Sawsan Morrar at The Sacramento Bee:
A small group of former students, advocates and parents gathered in front of the California Department of Education Monday to demand the closure of a school where a teen with autism stopped breathing and later died after being restrained by staff.
Nearly a dozen protestors said they were demanding the immediate closure of Guiding Hands School in El Dorado Hills. Those gathered also said they believed state regulators didn’t do enough to prevent the death of Max Benson, 13, who died Nov. 29, a day after school staff put him in a face-down restraint for an extended period of time.
Katie Kaufman, 20, a former Guiding Hands student who attended the school for two years until she left in 2012, attended Monday’s rally. Kaufman said she was put in a face-down prone restraint multiple times, and was once body slammed onto a cement floor resulting in a bloodied chin.
Doug Johnson at Fox40 Sacramento:

Tuesday, December 11, 2018

The Autism Services Market

 The Politics of Autism includes an extensive discussion of autism service providers.

Ronit Molko at Forbes:
The autism services market is estimated to be worth around $5 billion to $7 billion annually and it’s growing, with a total addressable market estimated between $50 billion and $90 billion. The majority of the services provided to individuals with autism are behavioral services and are provided at home, in school, or in a clinic setting. Most of these services are based on the science of applied behavior analysis, or ABA, which is a scientific method that employs specific techniques and principles to impart skills and bring about meaningful changes in behavior. ABA is the most widely funded treatment option that private insurance companies, or state or federal programs, will cover.
 While the current national players are acquiring smaller providers to grow their platforms, there are still many underserved communities and many opportunities for organic growth. As of 2016, it was reported that the top nine multi-site providers accounted for nearly $400 million in revenues – almost 40 percent of the market share, but the market, and these companies, have grown considerably in the past two years. Despite the efforts by investors to consolidate the market, there is still space for more providers on the national level.

Monday, December 10, 2018

A Death in El Dorado Hills

In The Politics of Autismdiscuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

At a California school, an autistic student stopped breathing after nearly an hour under prone restraint. Sawsan Morrar and Phillip Reese at The Sacramento Bee:
The boy, identified by the Sacramento County Coroner’s Office as Max Benson, 13, became unresponsive while in the restraint hold and died a day later at UC Davis Medical Center.
The incident took place Nov. 28 at Guiding Hands School on Windplay Drive, according to the El Dorado County Sheriff’s Office. Benson became unresponsive while being held in a ‘prone restraint’ for nearly an hour, according to a source familiar with the investigation.
In a letter sent to the school’s site administrator, Cindy Keller, on Dec. 5 from the California Department of Education and released to The Sacramento Bee through a California Public Records Act request, state regulators found “sufficient evidence” that the facility had violated multiple state rules governing how and when physical restraints can be used on students.
Those violations included using an emergency intervention — the prone restraint — for “predictable behavior,” using an emergency intervention as a substitute for the student’s personally-designed behavior intervention plan and using the restraint for longer than necessary.

Sunday, December 9, 2018

Social Media and Twice-Exceptional Students

 In The Politics of Autism, I examine the role of social media in the development of the issueSocial media can spread vaccine disinformation, but they can also provide autistic people and their families with a way to connect with one another and to press for government action.

Twice-exceptional students are both gifted and disabled.  Many are autistic. At Education Week, Sasha Jones writes:
Twice-exceptional parents are not the first to take advantage of online connection, offering support and information to those hungry for it, and even driving state and national-level change. The advocacy group Decoding Dyslexia, for example, grew out of social media and now has branches in all 50 states, 42 of which have passed dyslexia-specific laws.
Robbi Cooper, a parent involved in policy and advocacy at Decoding Dyslexia Texas, says that social media connects advocates involved in various parts of the legislative process and builds support from lawmakers and administrators.
"Social media allows the door to open when the door's not locked. If the door is locked, then they won't let you in—but that doesn't mean there's nothing you can do," Cooper said, indicating that continued growth and research can serve as the key. "Once they start listening to you and start taking you seriously, then they unlock the door."

Saturday, December 8, 2018

Unvaccinated in Oregon

Blair Stenvick at Portland Mercury:
In Oregon, where both libertarians and natural lifestyle devotees abound, the anti-vaccination mindset is particularly strong. At 7.5 percent, Oregon currently has the highest percent of kindergartners in the country whose guardians claim exemptions for vaccinations on philosophical or religious grounds. That’s a full percentage point higher than what Oregon recorded in 2017—and the figure has risen steadily since the early 2000s.
“There’s an extraordinary amount of information, much of it wrong, some of it right, on the internet,” says State Representative Mitch Greenlick, who chairs the health committee in the Oregon House of Representatives. “This is part of a wave of anti-science attitudes in the country, and even the state.”

Oregon parents are generally required to have their kindergartners vaccinated against diphtheria, measles, mumps, rubella, polio, chickenpox, Hepatitis A and B, and tetanus. But there are exemptions for kids who have medical conditions that would make vaccines dangerous—and for kids whose parents cite religious or philosophical objections to vaccines.
In 2013, Oregon passed a law requiring that parents who claim non-medical vaccine exemptions must either watch an hour-long online video about vaccines produced by the Oregon Health Authority (OHA) or discuss vaccines with a medical professional. But the law has failed to make a meaningful impact on vaccination rates: While Oregon’s rate dropped in 2015 from 7 percent to 5.8 percent, it climbed steadily to 7.5 percent between 2015 and 2018, making the exemption rate higher than before the law went into effect.

Friday, December 7, 2018

Bad Data on Special Ed Teacher Employment

Uncertainty is a major theme of The Politics of Autism.  Much of the uncertainty stems from the state of the science.  Some stems from bad data.

Christina A. Samuels and Alex Harwin at Education Week:
For more than four decades, the U.S. Department of Education has asked states to submit information on special education teacher employment, along with a raft of other information that the Individuals with Disabilities Education Act requires to be collected.

But the employment numbers that are submitted to the federal government are sometimes wrong—wildly so. In some cases, state data managers say the mistake is theirs. In other cases, state officials say they aren't sure where the federal government got the numbers, even though states are the ones responsible for submitting them.
Mississippi is another one of several states with implausible personnel numbers. Federal records show the special education teacher count at 3,770 for the 2005-06 school year. The number of teachers reported in federal records drops to 910 in the 2010-11 school year. It jumps again to 4,145 teachers in 2011-12. For 2015-16, the number of special education teachers reported in the state is 5,086.

Patrice Guilfoyle, the director of communications for the Mississippi education department, said that the state's records show that it has had around 4,000 to 5,000 special education teachers over the past decade. She could not explain the federal numbers.

Thursday, December 6, 2018

IDEA Full Funding

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act

A release from Senator Chris Van Hollen (D-MD):
Today U.S. Senator Chris Van Hollen (D-Md.) introduced the Keep Our Promise to America’s Children and Teachers (PACT) Act, which would put Congress on a fiscally-responsible path to fully fund Title I and the Individuals with Disabilities Education Act (IDEA) on a mandatory basis.
“When our children have access to a first-rate, quality education not only do they succeed, but our economy and our entire country succeed. Congress had the right intentions when it passed Title I and IDEA, but we have fallen short on the promises in the law to fully fund these critical programs. It’s time we kept our promises to kids today and to future generations. The Keep Our PACT Act will make sure we do just that,” said Senator Van Hollen.
Title I, which gives assistance to America’s highest-need schools, is a critical tool to ensure that every child, no matter the zip code, has access to a quality education. However, it has been deeply underfunded, shortchanging our most vulnerable students living in poverty. According to the Alliance to Reclaim Our Schools, the Title I formula was underfunded by $347 billion from 2005-2017. Maryland alone was shortchanged by $4.7 billion.
Similarly, IDEA calls on the federal government to fund 40 percent of the cost of special education, but Congress has never fully funded the law. Currently, IDEA state grants are funded at just 14.7 percent. In the state of Maryland, IDEA was underfunded by $316 million in 2017 alone and by nearly $3.5 billion between 2005 and 2017.
The Keep Our PACT Act would create a 10-year mandatory glide path to fully fund both Title I and IDEA, ensuring that education is a priority in the federal budget. It is supported by the National Education Association, the American Federation of Teachers, the Alliance to Reclaim Our Schools, and AASA, the School Superintendents Association.

Wednesday, December 5, 2018

The Number of Special Ed Teachers Has Fallen

 In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.

Christina A. Samuels and Alex Harwin report at Education Week:
The number of special education teachers nationally has dropped by more than 17 percent over the past decade, a worrisome trend in a career path that has seen chronic shortages for years.

An analysis of federal data by the Education Week Research Center shows that while the number of special education teachers was dropping, the number of students with disabilities ages 6 to 21 declined by only about 1 percent over the same time period. And as a whole, the number of teachers in all fields has gone up slightly over the past decade, as has overall enrollment.

For the 2015-16 school year, which offers the most up-to-date data, there was one special education teacher for every 17 students with disabilities. That's more special education students per special educator than the overall teacher-student ratio, which has held steady at about 1 to 16 for the past decade.

Tuesday, December 4, 2018

Antivax Sentiment Spreads Worldwide. And So Does Measles.

Angela Giuffrida reports at The Guardian:
Italy’s health minister has sacked the entire board of the Higher HealthCouncil, the country’s most important committee of technical-scientific experts who advise the government on health policy.
In a move on Monday night that shocked Italian scientists, Giulia Grillo, from the Five Star Movementa vaccine-sceptic party that has supported unproven cures for cancer – said it was “time to give space to the new”.
“We are the #governmentofchange and, as I have already done with the appointments of the various organs and committees of the ministry, I have chosen to open the door to other deserving personalities,” she wrote on Facebook.
The decision will mean the replacement of 30 board members, including the president, Roberta Siliquini, the head of the school of hygiene and preventive medicine at the University of Turin who was nominated in December 2017 by the former health minister Beatrice Lorenzin.
Zachary Young at Politico Europe reports that social media have helped antivax sentiment spread broadly, affecting France.
And if online activity in the U.S. is any indication, some of the vaccine skepticism in Europe could be driven by Russian bots.
In the online war for public opinion on vaccines, the French government is being overwhelmed. According to an October report from the European Commission, only 69.9 percent of French people agree that “vaccines are safe,” placing the country of Louis Pasteur — the 19th century biologist who discovered the principles of vaccination — 26th in the EU28 totem pole, ahead of only Bulgaria and Latvia. When it comes to the seasonal flu vaccine, France ranks last, with 51.8 percent of respondents feeling secure.
Part of the reason that France has fallen so low in EU rankings has to do with anti-vaccination ideas spreading virally on social media, according to health officials and observers of online activity. According to an April report by Printemps Prevention, a preventative health nonprofit, 18 of the 25 most-viewed YouTube vaccines videos in France take a skeptical position. On search engines, the report shows, anti-vaccine queries have increased by 130 percent over five years.

Eleven EU member countries currently fall below the relevant threshold for measles, which requires 93-95 percent vaccination rates, and outbreaks have surged on the Continent since 2017. Whereas the once-rampageous disease was “eliminated” from the Americas in 2016, Europe has this year registered some 41,000 measles cases causing 40 deaths, according to the World Health Organization.
Among 27 European countries measured by the OECD, France has the lowest rate of childhood vaccination for the disease.
Marie Werbregue, from central France, became mobilized in the debate after her daughter became autistic, which she attributes to vaccination. Now, she is president of the association “Info Vaccins France” and co-moderates a 10,319-member Facebook group on the subject.

From the World Health Organization:
Reported measles cases spiked in 2017, as multiple countries experienced severe and protracted outbreaks of the disease. This is according to a new report published today by leading health organizations.

Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease.

Using updated disease modelling data, the report provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunizations. However, reported cases increased by more than 30 percent worldwide from 2016.

The Americas, the Eastern Mediterranean Region, and Europe experienced the greatest upsurges in cases in 2017, with the Western Pacific the only World Health Organization (WHO) region where measles incidence fell.

“The resurgence of measles is of serious concern, with extended outbreaks occurring across regions, and particularly in countries that had achieved, or were close to achieving measles elimination,” said Dr Soumya Swaminathan, Deputy Director General for Programmes at WHO. “Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under-, or unimmunized children, we risk losing decades of progress in protecting children and communities against this devastating, but entirely preventable disease.”

Monday, December 3, 2018

Almost a Third of Autistic Kids Do Not Get Treatment

In The Politics of Autism, I write:
A child’s chances of getting an autism label vary by geography as well as social class. On a broad level, state definitions of autism are consistent with the federal definition. At the practical level, there are differences, especially when it comes to assessing social and emotional development, health, vision, hearing, and motor skills. In 2011, seven percent of students receiving IDEA services nationwide had an autism determination. But the figures varied by state. The states with the highest share of IDEA students with identified autism were Minnesota (12.8 percent), Oregon (10.6 percent), and Connecticut (10.1 percent). The lowest were Iowa (1.1 percent), Puerto Rico (2.1 percent), Montana (2.8 percent), Oklahoma and West Virginia (3.7 percent each).  

At JAMA Pediatrics, Guifeng Xu and colleagues have an article titled "Prevalence and Treatment Patterns of Autism Spectrum Disorder in the United States, 2016." 
Key Points
Question What are the current prevalence and treatment patterns of autism spectrum disorder (ASD) among US children?
Findings According to data from the 2016 National Survey of Children’s Health, among 43 032 US children aged 3 to 17 years, 2.79% were ever diagnosed as having ASD. Among 1115 children with current ASD, 43.3% were treated with behavioral treatment only, 6.9% with medication treatment only, 20.3% with both behavioral and medication treatments, and 29.5% with neither treatment.
Meaning The prevalence of ASD is relatively high in the United States, and about one-third of US children with ASD did not receive behavioral or medication treatment.
Importance Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Previous surveys have reported a steady increase in ASD prevalence in US children over the past decades. Several behavioral therapies and medications have been developed to treat the symptoms of ASD; however, little is known about the current status of treatment usage for children diagnosed as having ASD.
Objective To estimate the prevalence and treatment patterns of ASD among US children using nationally representative data.
Design, Setting, and Participants This study used data from the 2016 National Survey of Children’s Health, a nationwide, population-based, cross-sectional survey. We included 43 032 children aged 3 to 17 years. Data were collected through questionnaires completed by a parent or guardian. Data were analyzed from February 2018 to March 2018.
Main Outcomes and Measures Outcome variables included ASD diagnosed by a physician or health professional and the use of behavioral treatment or medication treatment among children with ASD.
Results Of the 43 032 included participants, 22 072 (51.3%) were male, and the mean (SD) age was 10.7 (4.4) years. The weighted prevalence of ever-diagnosed ASD and current ASD were 2.79% (95% CI, 2.46-3.12) and 2.50% (95% CI, 2.21-2.79), respectively. The state-level prevalence of ever-diagnosed ASD varied from 1.54% (95% CI, 0.60-2.48) in Texas to 4.88% (95% CI, 2.72-7.05) in Florida. Nationally, about 70% of children with current ASD (70.5%; 95% CI, 65.1-75.8) were treated; 43.3% (95% CI, 37.4-49.2) received behavioral treatment only, 6.9% (95% CI, 3.7-10.1) received medication treatment only, and 20.3% (95% CI, 16.5-24.1) received both behavioral and medication treatments. The remaining 29.5% (95% CI, 24.2-34.9) of children with current ASD did not receive either behavioral or medication treatment.
Conclusions and Relevance This study showed that the prevalence of ASD in the United States was relatively high, and it varied substantially across US states. Almost 30% of US children with ASD did not receive behavioral or medication treatment, which calls for a critical need to understand and address the barriers for those children to receive appropriate treatments.

Sunday, December 2, 2018

Pro-Vaccine State Legislation

A release, by Lauren Ingeno, from Drexel University:
Despite an uptick in anti-vaccine legislation proposed by state lawmakers in recent years, pro-vaccine bills were more likely to be enacted into law, according to a new study by researchers at Drexel University. The results were published this week in the American Journal of Public Health.

"It is reassuring to know that the legislative process is working in favor of public health. It is concerning that there are so many anti-vaccination bills introduced, but our study shows that those bills are rarely signed into law," said study principal investigator Neal D. Goldstein, PhD, an assistant research professor in Drexel's Dornsife School of Public Health.
The use of nonmedical exemptions from vaccination requirements increased nationwide by 19 percent from 2009 to 2013, which has led to a disease resurgence in communities across the United States. However, both pro- and anti-vaccination policies vary widely state-by-state. The Drexel study, which analyzed all proposed and enacted vaccine legislation at the state level between 2011 and 2017, offers one of the first in-depth pictures of the country's vaccination policy climate.
"If you only look at current laws, that's history. But analyzing proposed bills gives us a flavor for what's happening now, and perhaps for what's to come. Are we seeing trends that may be concerning for the future?" Goldstein said.
During the seven-year study period, 175 bills related to immunization exemptions were introduced in state legislatures, with the volume increasing significantly over time. In 2011, there were 14 total bills proposed, compared to 41 in 2017.
The researchers found that the majority of vaccination legislation activity between 2011 and 2017 was consolidated to four states: New Jersey (29 total bills), New York (28), West Virginia (15) and Mississippi (12). New Jersey introduced the highest number of anti-vaccination bills (24), while New York and West Virginia introduced 14.
Of the 175 vaccination bills introduced, 92 (53 percent) were classified as anti-vaccine, and 83 (47 percent) were classified as pro-vaccine. Thirteen of the total number of bills (7 percent) were signed into law.
Although the majority of proposed legislation would have expanded access to vaccine exemptions, bills that limited exemptions -- meaning they eliminated or made it more difficult for parents to opt their children out of mandatory school immunization requirements -- were overwhelmingly more likely to be enacted into law. Only one anti-vaccination bill, 2011 Washington bill SB5005, ultimately became law. The law broadened the types of health care providers, beyond licensed physicians, who could sign a vaccination exemption form.
Pro-vaccine laws are an important protector for the public's health, according to Goldstein, because such a high proportion of the population needs to be vaccinated to prevent an outbreak of contagious diseases. Measles, for example, require about 95 percent of the population to be immunized. Those who choose not to vaccinate their children for non-medical reasons are putting communities at risk, evidenced by states across the country experiencing record-high disease outbreaks this year, Goldstein said.
The recent anti-vaccination movement gained momentum after a study published in The Lancet in 1997, which suggested a link between the MMR (measles, mumps and rubella) vaccine and autism spectrum disorder. The study was subsequently debunked and retracted, and its author, Andrew Wakefield, lost his medical license.
However, that has not stopped a small, vocal minority of Americans from continuing to spread misinformation about the perceived health risks of vaccines. And Goldstein's recent study shows that the dangerous rhetoric has found its way into state legislatures.
New Jersey Assembly Bill 497, for example, would have exempted children under six years of age from the hepatitis B vaccine requirement if the child's mother tested negative for hepatitis B during her pregnancy. The bill explicitly linked "multiple sclerosis, chronic arthritis, autism spectrum disorder, and diabetes" as a "diseases or adverse unintended consequences associated with receipt of the hepatitis B vaccine." There is no scientific evidence to support the bill's claims, Goldstein said.
"Several of the bills we saw were clearly not evidenced-based," he added. "This serves as an opportunity for pro-vaccination constituents to become involved in the legislative process and ensure that state laws reflect the state of science."
Jonathan Purtle, DrPH, an assistant professor at Drexel's Dornsife School of Public Health, and Joanna S. Suder, JD, deputy attorney general at the Delaware Department of Justice, co-authored this paper.V

Saturday, December 1, 2018

Bush and Disabilities

In The Politics of Autism, I discuss the civil rights of people with autism and other disabilities

In 1990, President George H.W. Bush signed PL 101-476, which changed the title of the Education for All Handicapped Children Act to Individuals with Disabilities Education Act (IDEA). The new law added two categories of eligibility to federal special education law -- autism and traumatic brain injury -- and mandated transition services.

In the same year, Bush also signed the Americans with Disabilities Act (ADA), the nation's first comprehensive civil rights law addressing the needs of people with disabilities, prohibiting discrimination in employment, public services, public accommodations, and telecommunications.

The Bush administration's role in ADA was not passive.  As Joseph P. Shaprio explained in his book, No Pity: People with Disabilities Forging a New Civil Rights Movement, EEOC Chairman Evan Kemp and White House counsel C. Boyden Gray played key roles in passing the law.

And today, America welcomes into the mainstream of life all of our fellow citizens with disabilities. We embrace you for your abilities and for your disabilities, for our similarities and indeed for our differences, for your past courage and your future dreams. Last year, we celebrated a victory of international freedom. Even the strongest person couldn't scale the Berlin Wall to gain the elusive promise of independence that lay just beyond. And so, together we rejoiced when that barrier fell.
And now I sign legislation which takes a sledgehammer to another wall, one which has for too many generations separated Americans with disabilities from the freedom they could glimpse, but not grasp. Once again, we rejoice as this barrier falls for claiming together we will not accept, we will not excuse, we will not tolerate discrimination in America.
With, again, great thanks to the Members of the United States Senate, leaders of whom are here today, and those who worked so tirelessly for this legislation on both sides of the aisles. And to those Members of the House of Representatives with us here today, Democrats and Republicans as well, I salute you. And on your behalf, as well as the behalf of this entire country, I now lift my pen to sign this Americans with Disabilities Act and say: Let the shameful wall of exclusion finally come tumbling down. God bless you all.