By Therese Derovanessian, M.D.
Physiatry Forward, Association of Academic Physiatrists, Summer 2025
Mr. Johnson arrived on the inpatient rehabilitation floor unable to move the left side of his body, barely able to speak after a massive stroke. Day by day, with intensive therapy, he began to regain his speech and mobility.
Ms. Tammy, who lives with cerebral palsy, came in with her caregiver to replace her broken wheelchair after years of use. Her replacement allowed her to maintain her independence.
What both patients had in common, and the only reason they could access this essential care, was that they, like 43% of all non-elderly disabled adults, were covered by Medicaid.
Physiatrists have seen what happens when patients are denied medically necessary rehabilitationānot because it is not indicated, but because of insurance coverage. The proposed āOne Big, Beautiful Billā Act threatens to restrict essential access to rehabilitation services further. The bill would slash $700 billion from Medicaid over the next decade through eligibility restrictions, benefit reductions, and privatization. (1) According to the Congressional Budget Office, nearly 11 million Americans could lose coverage entirely. (2) This is particularly alarming for the disability community, who account for 72% of all Medicaid expenditures (3) and account for 15 million people. (4)
For our patients, Medicaid isnāt a safety netāitās the foundation for survival. (5) The consequences of gutting Medicaid go far beyond numbers on a spreadsheetāthey are felt most acutely by people with disabilities. The Houseās 2025 budget proposal would slash over $2 trillion in programs serving low- and moderate income Americans, with Medicaid bearing a major brunt. For people with disabilities, this could mean losing access to home care, personal attendants, assistive equipment, or even institutional careā services that are often life-sustaining. According to the Center on Budget and Policy Priorities, (6) many of the proposed changes are not designed with the unique realities of disability in mind: they ignore that many disabled individuals cannot meet work-reporting requirements and already face extensive administrative hurdles.
Disability rights activist Julie Farrar recently said in an interview, (7) āI was born missing 12 vertebrae, and every six months, I have to prove Iām still disabled enough to qualify.ā
The disability community is already subject to exhausting eligibility reviews and coverage instability. Further cuts will only deepen this issue, isolating people from the care that supports their survival, independence, and dignity.
We must reject this direction.
Physiatrists are at the frontlines. We understand the value of function, the cost of losing it, and our patientsā long, nonlinear journeys. We cannot stay silent as access to that care is eroded.
While we defend Medicaid, we must also look forward. A well-designed single-payer systemāsuch as that proposed by Physicians for a National Health Program (PNHP)ā would ensure continuity, equity, and dignity. Critically, it would include:
- Home and Community-Based Services (HCBS)
- Inpatient rehabilitation and long-term post-acute care
- Durable Medical Equipment (wheelchairs, ventilators, communication devices)
- Personal care attendants and in-home nursing
- The urgency is real. In May 2025, ADAPT activists were arrested at the Capitol, demanding the protection of Medicaid and the civil rights of disabled Americans. This is not a theoretical debateāit is unfolding now at the intersection of medicine, policy, and survival.
As physicians and physiatrists, we must:
- Refuse to normalize exclusion from rehabilitation and lifesaving services
- Advocate for payment models that center human dignityānot just cost-efficiency
- Bring disabled voices into PNHP, medical education, and every space where care systems are designed
Physiatry was built to restore function and preserve independence. We must use that expertise to build a system that includes everyoneānot just those who can afford to fight for it.
Dr. Therese Derovanessian is an Armenian-American from Seattle, Washington who recently graduated from medical school in New York and is now an incoming preliminary medicine resident at NYU Langone Long Island. She will continue her advanced PM&R training at Johns Hopkins.
Therese is passionate about disability justice, health policy, and advancing global rehabilitation care. She actively advocates for legislation impacting her patientsā lives and believes physician voices are essential at the policy table. Clinically, Therese gravitates toward interventional pain management, especially for oncological and medically complex patients. However, she remains open-minded and curious, finding nearly every subspecialty within physiatry engaging and full of possibility.
References:
- Freking K, Mascaro L. Trumpās big tax bill has passed the House. Hereās whatās inside it. AP News. https://apnews.com/article/trump-tax-breaks-billmedicaid-80b5781377bcd0870a1dccb3c7b8dc05. Published May 22, 2025. Accessed June 19, 2025.
- Burns A, Ortaliza J, Lo J, Rae M, Cox C. How will the 2025 reconciliation bill affect the uninsured rate in each state? Allocating CBOās estimates of coverage loss. Kaiser Family Foundation. https://www.kff.org/affordable-care-act/issue-brief/how-will-the-2025-reconciliation-bill-affect-the-uninsured-rate-in-each-state-allocating-cbos-estimates-of-coverage-loss/. Published June 6, 2025. Accessed June 23, 2025.
- Okoroa CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults ā United Statues, 2016. MMWR Morb Mortal Wkly Report. https://www.cdc.gov/mmwr/volumes/67/wr/mm6732a3.htm#suggestedcitation. Published April 17, 2018. Accessed June 19, 2025.
- Burns A, Cervantes S. 5 Key Facts About Medicaid Coverage for People With Disabilities. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-coverage-for-people-with-disabilities/. Published February 7, 2025. Accessed June 23, 2025.
- Khavjou OA, Anderson WL, Honeycutt AA, et al. National Health Care Expenditures Associated With Disability. Med Care. 2020;58(9):826-832. doi:10.1097/ MLR.0000000000001371
- Center on Budget and Policy Priorities. 2025 Budget Impacts: House Bill Would Cut Assistance and Raise Costs for People With Disabilities. https://www.cbpp.org/research/federal-budget/2025-budget-impacts-house-bill-would-cut-assistance-and-raise-costs-for-1. Published June 9, 2025. Accessed June 23, 2025.
- Interview with Julie Farrar [Interview Transcript]. āIt Is Going to Kill Peopleā: Disability Rights Activist Speaks Out on Trumpās āBig, Beautiful Bill.ā Democracy Now!. https://www.democracynow.org/2025/5/21/disability_rights_activists_budget_bill. Accessed May 21, 2025. Accessed June 23, 2025.