Editor's note:
This new piece originally ran in the Dec. 8 print edition. Some corrections have been made.

With all the debate over health care reform, few have talked about what it will mean to people with disabilities. Last month a panel of experts in the disability rights field discussed the issue at the American Public Health Association's 137^th Annual Meeting in Philadelphia.

Meeting at the Hyatt Regency, the six panel members exchanged viewpoints as to the pros and cons of the House reform bill that passed last month.

Opinions were varied, and at times emotions ran high. While most panelists were in favor of passing anything they considered a first step in the process, others were very much against the bill. The most vocal of them was Margaret Nosek, PhD, director of the Center for Research on Women with Disabilities at Baylor University in Waco, Texas. Nosek, who is herself disabled, attended the conference by video hook-up. She is considered one of the foremost researchers in the disability field today.

"The negatives far outweigh the positives in the reform bill," she said. "I just don't see that this is sustainable. As long as you are forcing people to buy insurance in an over-priced market, it isn't sustainable."

And Nosek laid on the table what she considers the biggest obstacle to all people with disabilities today.

"We have to maintain our poverty to be eligible for health care coverage," she said. "This is unconscionable. We cannot work if we want health care. "

A large portion of people with disabilities in the United States do not work, for many reasons. But those who are able to work often don't seek employment for two reasons:

?because current legislation reduces Social Security disability income when the individual begins working, regardless of the whether of not he or she is earning a livable wage, and

? because they cannot afford the kind of health care coverage they need through normal channels.

For these reasons, in almost 20 years, the Americans with Disabilities Act has failed to significantly increase the number of people with disabilities in the United State who work. It has, instead, become a tool used by people who are injured on the job to seek accommodation.

Nosek believes that expanding Medicare to people with disabilities under retirement age is the real answer. "A uniform 5 percent across-the-board tax would pay for it," she told the panel.

Nevertheless, most panelists didn't want to wait any longer for help.

"People with disabilities are hurt by current legislation very much," said Ari Ne'Eman, a senior at the University of Maryland and representing the Autistic Self-advocacy Network. "This legislation needs to pass. Future legislation will probably be more generous."

He agreed with Nosek that, as a longtime user of services and supports because he has autism, often those services aren't actual health care, though they are funded by Medicaid. "But because Medicaid might be expanded, it is feared that states will cut support for community services to pay for it. This doesn't have to happen. We need to put in some safeguards."

Joe Caldwell, PhD, a Kennedy Fellow and policy analyst with the Association of University Centers on Disabilities (AUCD) and adjunct assistant research professor with the Department of Disability and Human Development at the University of Illinois-Chicago, reminded his colleagues that there are good points about the pending legislation.