
Disability in the United States

Americans with disabilities are a significant minority group in the United States, making up a fifth of the overall population and over half of Americans older than eighty. There is a complex history underlying the United States and its relationship with its disabled population, with great progress being made in the last century to improve the livelihood of disabled citizens through legislation providing protections and benefits. Most notably, the Americans with Disabilities Act is a comprehensive anti-discrimination policy that works to protect Americans with disabilities in public settings and the workplace.
Definitions.
According to the Social Security Advisory Board, when the federal government first began provisioning funds for state-run disability assistance programs, eligible beneficiaries were defined as needing to be "totally and permanently disabled." In 1956, this definition was expanded by the Disability Insurance Program to describe disability as the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or to be of long-continued and indefinite duration." Critics indicated that this language limited the concept of disability to an occupational scope, and more holistic definitions were adopted as time passed. The modern consensus on disability within governmental, medical, sociological realms in the United States is that it includes impairments that either physically or mentally incapacitate individuals from engaging in significant life activities, or the perception of possessing such an impairment. For instance, in a 2013 study, the Centers for Disease Control and Prevention (CDC) evaluated disability across five dimensions: vision, cognition, mobility, self-care, and independent living. Specific conditions that fall under this umbrella vary circumstantially, however it is broadly accepted that disability includes, but is not limited to the following:
History.
At a federal level, legislation pertaining to disability was limited in the 18th and 19th centuries, with notable laws at that time including an act for the relief of sick and disabled seamen, which was signed by John Adams in 1798. In the early 1900s Eugenic Sterilization Laws were passed in several states, permitting governments to conduct forced sterilization on individuals with mental disorders. The 1927 Supreme Court case "Buck v Bell" upheld the constitutionality of such legislation, with such laws being banned nearly half a century later with the 1978 Federal Sterilization Legislation, although loopholes have been exploited with such sterilizations continuing into modern times. The burgeoning of disability rights legislation in the 1900s came after World War I with congress' establishment of the Rehabilitation Programs, which provided education and healthcare support to recovering veterans. Significant progress came in the 1930's with the presidential election of Franklin D. Roosevelt, who was physically disabled himself, and his signage of the Social Security Act.
Progress towards disability justice came in hand with the civil rights movement in the latter half of the 20th century. In 1961 the American National Standards Institute published a document overviewing building accessibility limitations for physically disabled individuals, which supported the passage of the Architectural Barriers Act of 1968 and encouraged several states to adopt inclusive accessibility legislation in the '70s. Additionally in the 1960s, Medicaid and the Mental Retardation Facilities and Community Mental Health Centers Construction Act were passed, allocating funds towards healthcare and the developments of statewide councils, advocacy frameworks, and post-secondary education pathways for disabled citizens. In the 1970's major anti-discrimination legislation was enacted with the repeal of the last "Ugly law," which permitted law enforcement to incarcerate people for appearing disabled, as well as the 1973 Rehabilitation Act and Individuals with Disabilities Education Act (IDEA) which prevented institutions that received public funding from discriminating on disability status. The 1980s oversaw saw an additional movement towards accessibility with the passage of the Air Carrier Access Act, Fair Housing Amendments Act, and Technology-Related Assistance for Individuals with Disabilities Act and justice with the creation of the Civil Rights of Institutionalized Persons Act (CRIPA).
In 1990, the Americans with Disabilities Act (ADA) served as a landmark bill outlining more comprehensive protections and accommodations for the disabled community, with other legislation, introduced later that decade such as the Telecommunications Act and the Ticket to Work and Work Incentives Improvement Act (TWWIIA) expanding upon the ADA. The turn of the Millenium oversaw crucial Supreme Court cases such as "Olmstead v. L.C." and "Tennessee v. Lane" which upheld federally outlined disability rights.
Demographics.
According to the "Disability Status: 2019 - Census 2019 Brief" approximately 20% of Americans have one or more diagnosed psychological or physical disability:
Census 2000 counted 49.7 million people with some type of long-lasting condition or disability. They represented 19.3 percent of the 257.2 million people who were aged 5 and older in the civilian non-institutionalized population -- or nearly one person in five..."
This percentage varies depending on how disabilities are defined. It may be helpful to note that disability in the United States is classified under different types of physical or mental impairments of which include one's ability to physically function, mental status, including decision skills and memory, the ability of sight, if they are self-sufficient, and finally, if they depend on anyone to help them do tasks . According to "Census Brief 97-5", "About 1 in 5 Americans have some kind of disability, and 1 in 10 have a severe disability. Not only does this statistic affect those who are disabled, but individuals with disabilities not only endure disadvantages but so do their children or possibly grandchildren as they can potentially be left facing health care disadvantages as well as education."
The United States Census Bureau is legally charged with developing information on the type and prevalence of disability in the population. Statistics reveal the highest percentage of individuals with a disability reside in southern areas such as Texas, Florida, Mississippi, and anywhere along the southern coast. The states that include the fewest disabled individuals are western areas of which will include Wyoming, Colorado, and Utah. These disabled people are protected by three primary laws. They include the Americans with Disabilities Act, Individuals with Disabilities Education Act, and Section 504 of the Rehabilitation Act. The primary purpose of collecting ACS data on disability is to help the US Congress determine the allocation of federal funds and inform policies. It is also used to identify the characteristics of the disabled population of the United States. Determining the number and geographical location of people with disabilities is crucial for policies aimed at providing services like public transportation.
ACS does not directly measure disability There are other smaller survey studies that provide some insight on disability in the US. While studies like the National Health Interview Survey the Health and Retirement Study, the Behavioral Risk Factor Surveillance System, and the Health, Aging, and Body Composition (Health ABC) Study are used to infer valuable disability-related health characteristics in the US population. While responses to these items are commonly refer to as "disability", it could be argued the 
—it uses self- and proxy-reports to evaluate perceived ability to perform functional tasks. Existing publications have delineated details on the US population regarding disability by using information from the ACS. Publications have also outlined issues with disability data in the ACS. Research on disability continues to improve, and potential remedies are found for current methodological challenges. Because of the uniqueness, regarding federal funding and policy, researchers from various fields (e.g., sociology, epidemiology, and government) make wide use of ACS data to better understand disability in the US.
African Americans.
According to the 2000 U.S. Census, the African American community has the highest rate of disability in the United States at 20.8 percent, slightly higher than the overall disability rate of 19.4%. Given these statistics, it can be suggested that African Americans with disabilities experience the most severe underemployment, unemployment, and under-education compared to other disability groups. For instance, the 2015 American Community Survey indicates that African Americans who have disabilities live in poverty at a rate of 1.5 to 2 times greater than other racial groups in America.
Criminal justice.
Data obtained in the National Longitudinal Survey of Youth indicates that Black men with disabilities encounter the greatest cumulative probability of being arrested by age 28, in contrast to others with either different gender, disability, or race status. With respect to African American women re-entering society after serving time, a "JHCPCU" article identified disability, more specifically positive HIV/HCV status, as a major factor correlated with lowered usage of various modes of health care such as alternative and emergency care. Calls for civil rights and criminal justice reform with the Black Lives Matter movement have brought into public eye how Black individuals with disabilities disproportionately experience police violence. Instances cited as police brutality, such as the 2018 murder of Marcus-David Peters, an unarmed black man experiencing a mental health crisis, has motivated legislation such as Virginia's Mental Health Awareness Response and Community Understanding Services (MARCUS) alert bill, which would necessitate that cases of individual mental distress be attended to by both police and mental health professionals. Viral footage of the killing of Walter Wallace, a black man with a history of mental illness who was killed during a police encounter, has helped bring the Black Disabled Lives Matter movement into the public eye. 
Education.
Work published in the "Journal of African American History" suggest that the enduring consequences of segregation and separation of special education classrooms can potential have a negative compound effect on the quality of education for African American students with disabilities. An article in the "Harvard Educational Review" suggests that educational pedagogy designed to "cross-pollinate" across race and disability coalitions is an effective way to combat exclusion that particularly impacts Black disabled children.
Employment.
According to a study published in the "Journal of Disability Policy", Black people with disabilities experience significantly higher unemployment and lower monthly wages compared to the overall disabled community and general population. A research paper in the "Journal of Applied Rehabilitation Counseling" reported that counseling professionals identified that disability status can limit employment prospects of Black and Latino offenders seeking work opportunities.
Healthcare.
Disabled Black Americans face barriers to receiving comprehensive medical care to address their pre-existing health conditions. In studies published in the "Journals of Applied Gerontology" it was noted that elderly African American women face a greater likelihood of acquiring disability in comparison their white counterparts, and additionally are more likely to rely on medicaid for coverage. The same journal articles established a correlation between being uninsured or utilizing medicaid coverage with greater levels of disability. With respect to disabled youth, it was found that when controlling for socioeconomic and insurance status, Hispanic and Black children with disabilities were less likely to have received specialty medical care in comparison to children from other racial backgrounds according to research published in the journal "PEDIATRICS".
Disparities.
Discrimination in employment.
The US Rehabilitation Act of 1973 requires all organizations that receive government funding to provide accessibility programs and services. A more recent law, the Americans with Disabilities Act of 1990 (ADA), which came into effect in 1992, prohibits private employers, state and local governments, employment agencies, and labor unions from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, or in the terms, conditions, and privileges of employment. This includes organizations like retail businesses, movie theaters, and restaurants. They must make reasonable accommodation to people with different needs. Protection is extended to anyone with (A) a physical or mental impairment that substantially limits one or more of the major life activities of an individual, (B) a record of such an impairment, or (C) being regarded as having such an impairment. The second and third criteria are seen as ensuring protection from unjust discrimination based on a perception of risk, just because someone has a record of impairment or appears to have a disability or illness (e.g. features which may be erroneously taken as signs of an illness). Employment protection laws make discrimination against qualified individuals with a disability illegal and may also require the provision of reasonable accommodation. Reasonable accommodations includes changes in the physical environment like making facilities more accessible but also include increasing job flexibility like job restructuring, part-time or modified work schedules or reassignment to vacant position. Though many hold attitudes that are more enlightened and informed than past years, the word “disability” carries few positive connotations for most employers. Negative attitudes by employers toward potential employees with disabilities can lead to misunderstanding and discrimination.
Healthcare disparities.
The disability paradox, a concept that recognizes the tendency for individuals without disabilities to perceive their disabled counterparts as having poorer livelihoods than disabled individuals would view themselves, is perpetuated in healthcare settings, with research published in the "Handbook of Disability Studies" identifying that practitioners award lower quality of life scores to disabled individuals than a member of the general population would. An article in the "Kennedy Institute of Ethics Journal" expresses that as a consequence physicians frequently go into consults with rigid, skewed perceptions of their patient's disabilities. Anita Ho, a bioethicist, argues that heightened practitioner confidence can harmfully impact disabled individuals in this regard as it increases the likelihood that patients may distrust their physicians or conversely place excessive faith in their care provider's insight into their condition. Disparate in healthcare access also impact disabled populations, for instance, most rural areas — especially in the Great Plains region — have little or no government-organized medical support infrastructure for the permanently disabled indigent population which results in disability in the United States not only affecting individuals physically and mentally but socioeconomically as well.
Poverty.
Investigations on the "poverty and disability nexus" have consistently shown poverty and disability are correlated for all race-ethnic groups within the United States. Financial stability of people with disabilities would decrease the dependence on governmental support programs. Studies have been done with the U.S. Census Bureau data to examine the high prevalence of disabilities among welfare recipients. Thirteen percent of families with children under the age of 18, who are also receiving welfare benefits, had at least one child with a disability. Families with income below twice the poverty line were 50% more likely to have a child with a disability than those families with higher incomes. Children with disabilities from families with annual household incomes of higher than $50,000 were more likely to attend higher education.
Research suggests higher education does impact employment and income opportunities for people with disabilities. It is also noted near equivocal employment opportunities and salaries for people with disabilities to their peers without disabilities. While only one-fifth of people in the United States have at least a four-year college degree, some studies note possessing a four-year degree is the difference between absolute job security and joblessness.
Public resources.
Social Security Administration.
The US Social Security Administration (SSA), defines disability in terms of an individual's inability to perform substantial gainful activity (SGA), by which it means “work paying minimum wage or better”. The agency pairs SGA with a list of medical conditions that qualify individuals for disability benefits. Individuals who are disabled will receive insurance and this ensures they will always be getting paid when they must take time off work or cannot work due to the severity of their illness. The SSDI and the SSI are both social security programs that will assist in payments.
The SSA makes available to disabled Americans two forms of disability benefits: Social Security Disability Insurance, (SSDI) and Supplemental Security Income (SSI). Briefly, the SSDI is a program that is useful in the sense that it is like welfare, but you must have been able to work enough hours throughout your life and you must have paid social security taxes in order to be approved. This benefit is most useful for those who do not have severe disabilities or illnesses because those who are immobile will not have been able to work. The good thing about this benefit does not only do it benefit the individual, but it will benefit their family members as well. To go more in-depth, Social Security pays disability benefits to citizens who have worked long enough and have a medical condition that has prevented them from working or is expected to prevent them from working for at least 12 months or end in death. 
Looking at the SSI, the SSI insurance, or the Social Security Insurance program, is there to pay individual benefits who could not have worked or have little capital. However, for both of these insurances, the same approval is required by the individual's disability.
Some assistance ends if the beneficiary starts working. If that assistance (such as personal care or transportation) is necessary for work, it creates a welfare trap where it is not possible to work despite potentially being willing and able. Some programs do provide incentives to work.
Education.
K-12.
Before the Individuals with Disabilities Education Act was passed, children with disabilities were at-risk of not receiving a free, appropriate public education, but each act protecting the disabled individuals protects different criteria of which include differentiation in schools, the law by which schools must be up to date on the K-12 act, and equal service for the public who extend any services. For IDEA to apply, the child must first be determined to be able to benefit from public education. This benefit is not exclusively limited to school-aged children but applies to children with disabilities from infancy.
Due to the societal stigma of disability, children are sometimes treated like disabled children, and not included in activities in which other children were able to participate. However, for These individuals with any type of disablement such as learning disabilities or physical disabilities, the Americans with Disabilities Act covers them. This act ensures no one is discriminated against beyond their own home of which includes work, school, and anywhere in public. The places it does not cover will include sanctioned or private areas including one's home. Educators can hold students with disabilities to lower expectations, which impacts their future educational attainment. Although their future may be impaired the K-12 act is broad amongst education and Section 504 of the Rehabilitation Act will help clarify. This act ensures individuals who attended schools, play on school sports teams, or attend any off or on-campus events will be protected unless that school is not funded by the government. These students must be given compromises that other students may not receive due to their impairments.
Under the Individuals with Disabilities Education Act, the school district must provide every disabled child with an Individualized Education Plan (IEP). The IEP is compiled by a team of school administrators and guardians and may include a child advocate, counselors, occupational therapists, or other specialists. The Individuals with Disabilities Education Act ensures all fees for schooling are discharged, but these children must be approved under IDEA and must be in a certain category of disabilities. This act allows for any student or child to be assessed and is provided extra incentives that may apply to their condition. The IEP also evaluates the goals for the child and determines what needs to be done in order for those goals to be met. Children with disabilities who do not have a parent or guardian advocating on their behalf are not as well served in the education system as their peers with parent or guardian advocates.
Transition preparation from K-12 education to post-secondary education or career was initially written into IDEA to begin at age 12, but in the existing law, transition preparation does not begin until age 16. While this law provides a maximum age at which to begin transition preparation, students with disabilities have been known to receive transition preparation at a younger age, as the states might mandate a younger age, or the IEP team might determine a younger age is appropriate to begin the transition preparation of the student. Some students with disabilities have noted not receiving any transition preparation at all. The transition services are to be designed to be results-oriented rather than outcome-oriented. This is to ensure the transition services are designed for the student's success. Students are intended to attend their transition planning meetings with the IEP, yet not all students do. Some do attend, yet generally not take a leadership role - only fourteen percent do. This places the students with a disability in a passive role instead of an agentic role in their own life plans. In a 2007 study of a higher education institution located in the Midwestern United States, it was found that one-third of students with disabilities felt their transition preparation was lacking. Many in this group were unaware of laws that pertained to disability and higher education. This leaves them without an understanding of their learning needs and unable to advocate for themselves.
Higher Education.
Self-advocacy plays an important role in the success of students with disabilities in higher education. While the examination of self-advocacy skills has been largely limited to the impact in academic settings, self-advocacy skills, or the lack thereof, do also impact non-academic situations. A 2004 study noted that only 3 percent of students with disabilities had self-advocacy training. Students with disabilities who are confident about their disability identity and self-advocacy skills are more likely to disclose their disabilities and advocate for their needs when interacting with faculty and staff. Advocacy service is also provided to students as staff from different programs help instructors in college, understand the needs of the disabled who are attending their classes. So much so that when disable students need extra time to complete their course then some arrangements are made to cater to such students. Students with disabilities who were embarrassed of their disability identity and did not understand their needs as learners looked to faculty and staff for solutions to accommodation needs. Education helps students with disabilities learn self-advocacy skills that affect their ability to advocate for their health, insurance, and other needs.
In spite of IDEA and Section 504 providing support for the education of people with disabilities, the educational outcomes of people with disabilities vary significantly from the outcomes of people without disabilities. After high school, a 2005 study found students with disabilities enroll in postsecondary education, whether college, technical school or vocational school, at a rate of 46% compared to the rate of 63% for students without disabilities. This rate is up 23% since 1990, when the Americans with Disabilities Act of 1990 was passed. Specifically to four-year degree-granting higher education institutions, 27% of students with disabilities attend compared to 54% of students without disabilities. High school completion and postsecondary education enrollment vary per disability type.
Students with disabilities are responsible for advocating for their accommodations and needs as learners in higher education environments. Many higher education institutions have staff to work with students with disabilities on their accommodation requests. Higher education institutions do vary in process to obtain accommodations and accommodations provided. The staff members at the higher education institutions can recommend accommodations. The faculty members, however, may choose to vary or not implement the accommodations at all based upon concerns of weakening the academic integrity of the course or risking the possibility of endless accommodation requests. When working with faculty members about accommodations, nearly half of the students with disabilities recalled receiving a negative response, while the other half felt their faculty members were accommodating.
For people with disabilities, having a four-year college degree provides significant employment and salary advantages.
Employment and minimum wage exemption.
Disabled citizens in the United States receive Medicare insurance and social security benefits to varying degrees. For those that seek employment for therapeutic or economic reasons, the Fair Labor Standards Act of 1938 is applicable. This act was an attempt to facilitate the large number of disabled servicemen returning from the front lines "to the extent necessary to prevent curtailment of opportunities for employment". Section 14(c) provides the employers with a method of paying their disabled employees less than applicable federal minimum wage. The Secretary of Labor issues certificates that align wages with the employee's productivity.
At present there are 420,000 §14(c) employees being paid less than the minimum wage of $7.25 per hour. Administratively, the wage for the disabled was informally set at 75%. Those working in sheltered work centers have no minimum floor for their wage. The Fair Wages for Workers with Disabilities Act was proposed in 2013 to repeal §14(c) but was not passed.
Insurance.
It is illegal for California insurers to refuse to provide car insurance to properly licensed drivers solely because they have a disability. It is also illegal for them to refuse to provide car insurance "on the basis that the owner of the motor vehicle to be insured is blind," but they are allowed to exclude coverage for injuries and damages incurred while a blind unlicensed owner is actually operating the vehicle (the law is apparently structured to allow blind people to buy and insure cars which their friends, family, and caretakers can drive for them).