A recent article on Mic reminded me of something I have spoken about many times before, but never with consideration to actual policy. The article explores the lack of care that disabled women receive in relation to mammograms, and how this disproportionately affects the rate of women with disabilities who have breast cancer.

Because the article is focused on women with disabilities, it fails to acknowledge that this also greatly impacts trans men and  afab folks who are disableds, in relation to receiving mammograms, or breast care before and after top surgery. It also only briefly addresses other medical offices and procedures, which might not be accessible.

a woman in a wheelchair sits next to a small, empty examination table in a doctors office. It is a pink table with white paper crumpled on it. Another wheelchair user is sitting in the foreground on the right

The truth is accessibility matters for all disabled people, and it can impact everything from gynecology to general doctors visits, when receiving a physical.

Dental care can also be a huge problem, especially for wheelchair users, who may not be able to transfer from their wheelchairs. If doctors offices have steps but no ramps, too narrow doorways, small rooms with little room for wheelchairs, no access to lifts or other transfer devices, small tables disabled people can fall off of, or are too cramped and crowded, disabled people lack access.

Waiting rooms aren’t even designed with wheelchair users or mobility device users in mind, as they often lack accessible seating areas or supportive seating, causing disabled people and their devices to block aisle-ways for others.

Being a trans disabled person, I cannot ignore the fact that my other community, the trans community, faces similar barriers to health care, for completely different reasons. This is especially true for gynecological exams and mammograms for afab folks.

There is not only a large amount of stigma that is still surrounding transgender people, but it also has a great deal of impact on what kind of healthcare trans people receive. Stigma also affects disabled people, especially when it comes to mental health services, and to those with invisible disabilities.

We have heard a lot about health care from the Democrats fighting for the current Democratic nomination. Bernie Sanders has a plan he calls Medicare for all, which he believes will provide unlimited healthcare to every American. Hillary Clinton believes her plan to expand upon existing healthcare programs, particularly Medicare and Obamacare is more pragmatic, even though both candidates would prefer universal healthcare.

The difference is in whether they believe Congress would approve a single-payer system, at this current time. Bernie believes that it can be passed, and Hillary believes we are not there, currently.

What neither candidate is addressing is how healthcare already impacts disabled people. We can give disabled people as much access to healthcare, in terms of financing it, but if health care facilities are not accessible, it is for naught.

Requiring doctors offices to be accessible, and defining what that means is imperative to ensure disabled lives truly have access. Addressing stigma against trans people gender non-conforming people, and those with any disability is paramount to ensuring that disabled, transgender, and other non-binary Americans have the same access to healthcare as all Americans.

My greatest problem with Bernie Sanders’ plan is the fact that there is no clear discussion about how his healthcare plan will address disabled people, trans people, and other communities marginalized by the healthcare industry. Until he answers question that are imperative to ensuring fair and equitable treatment by healthcare professionals towards disabled and trans individuals, I urge those in the disability and trans communities to be cautious about indiscriminately accepting any healthcare reformation ideas that do not specifically outline the impact they will have on specific marginalized communities.

My questions for both candidates include:

-How will your overall healthcare plans affect disabled and trans/non-binary individuals in relation to their healthcare needs?

-What policy integrations have you specifically made to your healthcare plans, in relation to the healthcare problems disabled and trans/non-binary people face?

-How does your health care plan specifically address stigma healthcare professionals have against disabled and trans/non-binary people, which may specifically affect care in these communities?

The question that I have specifically for Bernie Sanders’ plan is:

-How will already existing services be integrated into your streamlined healthcare plan, without hurting disabled or trans/non-binary consumers?

I’m particularly interested in a response to this, because I experienced the streamlining of Medicare/Medicaid by Gov. John Kasich in Ohio, through the MyCare Ohio program, and the impact on disabled people wasn’t considered. This led to chaos, which resulted in home health care workers not being paid for six months or longer (my own included), doctors not being paid so they were refusing to see disabled and elderly people on the program, medication not being received because MyCare Ohio was not approving it for some people, equipment being rejected, healthcare files being lost (all of my equipment requests were lost with my file, forcing me to start over – a process that can and already had taken months), and at least one person dying.

Bernie Sanders wishes to streamline all insurance into one single-payer system. Streamlining 50+ state-based Medicaid programs (some are individualized by county), plus waiver services, plus MLTC plans, plus Medicare, plus Obamacare, plus private insurance, plus veterans health care programs, plus any other healthcare service into one program is going to take a lot of planning. MyCare Ohio was just one state between two programs.

Streamlining healthcare on a federal level and combining a multitude of different programs without the right considerations for disabled people, especially those of us who have the need for life-saving healthcare services, could be absolutely disastrous.

For both candidates and their campaigns, trans people have been virtually ignored. We are being killed. We are being murdered. We are killing ourselves. I believe lack of access to health care services was a major factor in the recent death of a trans disabled man in Arizona. Kayden Clarke may have been murdered by police, but his death was acerbated by the lack of access to the healthcare services he needed as a trans man.

Being denied access to hormones and other services pertinent to his transition was a major cause of the depression and dysphoria Kayden said he felt, which impacted both his mental health, and suicidal state of mind. With the right healthcare services, would the police have needed to be called? Would Kayden still be alive? There are strong indications that this would be true, but we may never truly know the answer.

Healthcare for all is not truly healthcare for “all” if everyone is not considered. As of now, we are unaware of how disabled people will be impacted by the healthcare plans of either candidate. We must urge them to discuss how marginalized communities will be affected by all of their policy plans, and we must advocate for the inclusion of disabled and transgender people in whatever plans they have. Our lives depend on it!!!

Photo Credit: Champaign County Healthcare Consumers