American voters see health care as the most important issue facing our country today, according to November’s exit polls. In response, Democratic presidential candidates have promoted versions of Medicare for All and universal health care which, they say, will fix our broken system.

Behind the promises, though, is the possibility that these plans will be devastating for disabled people — those of us who rely on health care the most. Even though it has long been one of the loudest constituencies in health care reform, the disability community is being marginalized in this debate.

In order to create a system that provides adequate health care for all Americans, today’s reform proposals must take into account the needs of disabled people. Failing to heed some of the most salient voices in the health care debate would be a strategic mistake for politicians as well as a clear betrayal of the community that needs these reforms most.

Democrats worked hard to ensure the Affordable Care Act included significant benefits for disabled Americans — a constituency which represents more than one-fourth of eligible voters, according to a study by Rutgers University. So when the time came to pass and defend the ACA, the disability community made its voice heard.

Across the country, disabled activists participated in high-profile protests and “die-ins” on Capitol Hill, some of which lasted for days. Many demonstrators were arrested multiple times over months of protests — but this strategy worked. Widespread public pressure generated by photos and media coverage of activists being forcibly removed from their wheelchairs by police was enough to derail repeal efforts.

Disabled people have long fought for a fairer health care system, and have been strong allies to Democrats who do the same. Without the grassroots efforts coordinated across the country by disability rights groups, the ACA likely would have faced repeal. Strategically speaking, Democrats need the support of disabled Americans for more reform efforts to succeed.

But today’s Medicare for All plans have a poor track record of including the needs of the disability community. Long-term services and supports, which provide disabled Americans the daily care and equipment they need, were even absent from original versions of Medicare for All.

Luckily, advocates have since made progress in securing the inclusion of LTSS in major Medicare for All proposals. However, the fact that it was absent in the first place means that policymakers failed to consider disabled Americans as a priority during the policymaking process. These candidates have failed to live up to the values of inclusion that universal health care plans supposedly promise. Those who use and rely on our health care systems the most should not have to fight for a voice in this debate.

Similarly, these plans fail to address the variance in quality and coverage of LTSS services across the country. Depending on where a disabled person lives, they could be denied access to specific benefits — an issue that disabled activists have tried to change for years.

Such location-dependent coverage limits beneficiaries’ ability to acquire basic care, like an aide to help them get out of bed or go to work. For example, in states like Florida or Alabama, disabled people of all ages are often forced into nursing homes because of the lack of coverage for basic in-home services.

Cost-sharing is another critical issue that emerges in Medicare for All systems. Medicare covers only 80% of medical benefits. For someone who is relatively healthy, this coverage may only leave a small gap to be paid by the beneficiary. But for disabled people, whose care can involve expensive medications or complex procedures, it could send them into bankruptcy.

In theory, Medicaid should cover the other 20% with its disability programs — but this only applies if the beneficiary is a low-income person. This creates a disability poverty trap, as those people who aren’t low income to begin with will likely become so after being burdened with high costs of care. Today, this problem is responsible for the high poverty rates of disabled Americans. If Medicare for All truly aims to eliminate barriers to health care, policymakers need to address cost-sharing problems for disabled beneficiaries.

Repeatedly, disabled people have had to fight to be included in policy debates that affect us as much as, or more than, other Americans. As some of the most practical experts on the problems with our health care system, Democrats need to include the disability community as they craft further plans for universal health care. Failing to do so would be devastating to the very Americans who need health care coverage the most, and would certainly fail to create a system “for all.”

Anna Landre is a sophomore in the School of Foreign Service. Discussing Disability appears online every other Tuesday.

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