Commentary: Health, civil rights of those with autism threatened by Trump administration policies

In a commentary for the New England Journal of Medicine, two leading public health experts suggest that some positions held by the Trump administration—both officially and unofficially—threaten the health and civil rights of individuals with autism and other developmental disabilities.

Colleen Barry, who chairs the Department of Health Policy and Management in the Johns Hopkins Bloomberg School of Public Health, joined forces to write the paper with David Mandell, a Hopkins alum who is now a professor and director of the Center for Mental Health Policy and Services at the University of Pennsylvania.

Together, they raise concerns about the Trump administration's proposed changes to health care laws and education laws, and point to what they view as harmful statements made by the president and other high-ranking officials.

"President Donald Trump's apparent openness to a long-debunked link between vaccines and autism risks encouraging Americans to stop vaccinating their children, posing a serious public health threat," they write. "Meanwhile, renewed attention to disproven theories about autism may be distracting us from growing threats to essential policies that support the health and well-being of people with autism and other disabilities."

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These essential policies that support those with autism include the expansion of Medicaid, which Barry and Mandell say is the "single largest health care payer for people with autism or developmental disabilities." By rolling back Medicaid expansions, the Trump administration could jeopardize access to health care for the 250,000 children with autism who received services through Medicaid in 2013, the most recent year for which data is available.

According to Barry and Mandell, there are other proposed changes to the Affordable Care Act—also known as Obamacare—that could affect crucial services provided to people with autism—services such as behavioral therapy, speech therapy, or physical therapy. Using block grants for Medicaid, for example, could reduce the federal funding states receive to pay for such services, and opening insurance markets that cross state lines could create a "race to the bottom," the authors say, in which state legislators are incentivized to repeal regulations and protections for people with autism in order to "make in-state health insurance products price-competitive" across state borders.

The authors note that the Trump administration's education reform policies could harm people with autism and developmental disabilities as well. The Individuals with Disabilities Education Act, in particular, guarantees that children with disabilities receive a free and appropriate public education. And yet, say Barry and Mandell, U.S. Attorney General Jeff Sessions has called the law an "irritating problem," and U.S. Secretary of Education Betsy DeVos has indicated that states should have the option to not enforce the law. Attacks on the IDEA Act threaten what the authors call "the single most important civil right afforded to children with autism or other disabilities."

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