CoffeyWritesImpact

Earlier this year, I was honored to give a speech at the Columbia University Nonprofit Management Health Policy Symposium. In my speech, I discussed the importance of valuing the social model of disability, which embodies the ideas of universal accessibility/design. Enjoy!

Social vs. Medical Model, at an Intersection with Public Health Policy

The oldest adopted societal norm of disability is the medical model, coined by Thomas Szasz in the mid-1950s, which views disability as resulting from an individual person’s physical or mental limitations and is not connected to the social or geographical environments (Gill, 1994). Already, this is problematic. The current use of the terms “cure” and “normal” paints disability as a problem that needs to be fixed, which has contributed strongly to dehumanizing trends. In fact, a recent NIH study has shown that this perspective has eroded trust in the health field, as many adults with disabilities continue to express substantial distrust in the medical community (Hogan, 2019). On the other side, there is the social model, which states that the “way to address disability is to change the environment and society, rather than people with disabilities” (Olkin, 2022). Essentially, the mismatch is between viewing disability as a problem to fix rather than working to create a more accessible landscape.

Current government and public health actions reflect a shift toward the medical model, which could have dire consequences for the 7.5 million students receiving accommodations in schools (National Center for Education Statistics, 2024). Specifically, the Department of Education, through the Office of Special Education and Rehabilitative Services, cut around 15 billion dollars from special education funding. While these cuts appear to be related to education policy, they are indicative of a governmental switch to the medical model, where there is a stronger focus on preventative cures rather than current accommodations for adults with disabilities. If this education-related health policy is a prediction of the future spending plans for the current 70 million people in the United States who live with a disability, there is a significant cause for concern (CDC, 2024).

In terms of medical model based funding, over 50 million dollars was awarded to research looking for prenatal and external causes of autism, one of the most common disabilities in the country (Vogel and Jacobs, 2025). By no means is this investment in autism medical development a negative; in fact, many medical professionals would argue that we should significantly increase that amount. However, this action is symbolic of a societal switch toward “fixing” disability rather than adapting the environment to be universally accessible. To focus on autism, it was recently reported that only 5% of adults with autism live independently, and 37% require overnight care (Forbes et al., 2023). Recent legislation has cut almost 1 trillion dollars in federal Medicaid funding, which funds social services for people with disabilities. With these cuts, the safety of the millions of adults with disabilities is in danger (Autism Speaks, 2025). This loss of funding is indicative of a shift in health policy away from social accommodations, which has already manifested in local examples.

In North Carolina, the Medicaid cuts began on October 1, with 3.1 million residents (many with disabilities) relying on the money for specialized care (Peterson, 2025). An example of an accommodation-based organization that lost 10 percent of its funding is ABC of NC, a nonprofit services provider that works with people with disabilities (Peterson, 2025). This is just one of many. In fact, by 2034, 10.5 million people will lose benefits nationwide. Just to show another local example, completely on the other side of the country in Nebraska, the state significantly reduced the pay of ABA therapists by 37-48% across the board. Once again, this shows how a reduction in Medicaid funding directly impacts the accommodations people with disabilities receive (Peal, 2025). These cuts will not stop, and they are felt in every community. Even more, they will continue to destroy the support systems for adults with disabilities, and we need external sources, such as the independent sector, to make up for it.

With the current focus on untested preventative treatments, as well as the slashing of support service funding, it is clear that public health policy is shifting toward Szasz’s medical model of disability. While it is incredibly important to note the significance of funding for cures and preventative treatments, it does not provide an excuse to ignore the 70 million adults living with disabilities. Universal Design comes from accessibility requirements through laws such as the ADA, IDEA, or Section 504, which benefit all people by reducing physical and intangible barriers to access. However, states, cities, and local governments require resources to implement these social services, which will not happen without Medicaid and the Office of Special Education and Rehabilitative Services. With this current shift in funding, the outdated medical model will continue to dominate health and disability related policy.

That is why nonprofit support is so important. Remember that number: 70 million adults in the country. That is why we need organizations, nonprofits, and NGOs such as yourselves to donate time, money, and resources to support and educate people about the community of people with disabilities. I am dedicating this speech to my brother, Parker, who is currently an adult with autism who receives government support. For him, and for everyone with disabilities, we must fight for inclusion.

References

Autism Speaks. (2024, August 30). Medicaid cuts coming: Protect autism services. https://www.autismspeaks.org/advocacy-news/medicaid-cuts-coming-protect-autism-services

Centers for Disease Control and Prevention. (2024, July 16). CDC data shows over 70 million U.S. adults reported having a disability. U.S. Department of Health and Human Services. https://www.cdc.gov/media/releases/2024/s0716-Adult-disability.html

Forbes, G., Kent, R., Charman, T., Baird, G., Pickles, A., & Simonoff, E. (2023). How do autistic people fare in adult life and can we predict it from childhood? Autism Research: The Official Journal of the International Society for Autism Research, 16(2), 458–473. https://doi.org/10.1002/aur.2868

Gill, C. (1994). Two models of disability. Chicago Institute of Disability, University of Chicago.

Hogan, A. J. (2019). Social and medical models of disability and mental health: Evolution and renewal. CMAJ: Canadian Medical Association Journal = Journal de l’Association médicale canadienne, 191(1), E16–E18. https://doi.org/10.1503/cmaj.181008

National Center for Education Statistics. (2024). Students with disabilities: Condition of education. U.S. Department of Education, Institute of Education Sciences. Retrieved [Month Day, Year], from https://nces.ed.gov/programs/coe/indicator/cgg

Olkin, R. (2022, March 29). Conceptualizing disability: Three models of disability. American Psychological Association. https://www.apa.org/ed/precollege/psychology-teacher-network/introductory-psychology/disability-models

Peal, J. (2024, September 25). ABA is essential: Nebraska families, providers concerned about Medicaid rate cuts for autism services. Nebraska Public Media. https://nebraskapublicmedia.org/es/news/news-articles/aba-is-an-essential-nebraska-families-providers-concerned-about-medicaid-rate-cuts-for-autism-services/

Petersen, C. (2024, September 19). Medicaid cuts impacting special care providers. WXII 12 News. https://www.wxii12.com/article/medicaid-cuts-impacting-special-care-providers/

Turner, C. (2025, October 13). Amid shutdown, Trump administration guts department overseeing special education. NPR. Retrieved from https://www.npr.org/2025/10/13/nx-s1-5572489/trump-special-education-department-funding-layoffs-disabilities 

Vogel, G., & Jacobs, P. (2023, April 3). Trump’s autism initiative embraces little-tested vitamin treatment. Science. https://www.science.org/content/article/trump-s-autism-initiative-embraces-little-tested-vitamin-treatment