The contentious debate going on in our country is primarily focused on one critical question: what is the balance of the roles between the federal and state governments?
For disability advocates who have spent years fighting for federal legislation to end the institutional bias, you would think their vote would be to support a strong federal role. The answer however is not that simple.
At the state level is where all Medicaid programs are implemented. Who the Governor is determines who the Medicaid Director is. Who is elected to the State Legislature determines funding levels as well as policy decisions that affect things such as level of consumer direction, nurse delegation, wage rates for attendants, types of waivers and programs provided, as well as more macro but extremely important legislative decisions such as redistricting, etc.
If the institutional bias was gone tomorrow, we would still be confronting some of these same issues at the state level the next day.
In the DEFENDING OUR FREEDOM Campaign the question isn't “Should we end the institutional bias?”
We agree - YES!
The strategic tactical question is: the balance of our advocacy resources between federal and state action.
Remembering the old adage “all politics are local" might be helpful in deciding what that balance should be.