The article is written by a disability advocate and author living with a C4 spinal cord injury, who draws from personal experience and community advocacy to push for accessibility and equity.
“Do Better”
Before my spinal cord injury, I didn’t think much about getting from Point A to B. I drove a few clunkers in my day that I paid pennies for. If they didn’t start, I could jump in anyone's passenger seat. Now that I require a wheelchair accessible vehicle to accommodate my power wheelchair, getting to where I need to go is significantly more challenging. Wheelchair accessible vehicles are expensive, and transit options are limited. I live in a small town but that’s just part of it: the bigger picture is systemic, and widespread: affecting a whopping 96% of the 5.5 million Americans who use wheelchairs and can’t afford wheelchair accessible vehicles.
So how can people with disabilities who use mobility aids like wheelchairs participate in our communities, or even access rides to the doctor? What does this isolation look like and what are the lasting impacts of inaccessibility trends in transportation? Most importantly, how can we advocate for ourselves as wheelchair users, in a society that consistently marginalizes us like we’ve got nowhere to be?
The High Cost of Wheelchair Accessible Vehicles
Only 4% of wheelchair users can simply roll out the door and access a private vehicle. Car manufacturers produce few accessible models, and conversions can be as expensive as the vehicle itself.
Prices range from $65,000 to almost $100,000 for new fully converted wheelchair vans, and pre-owned accessible vehicles are haare only slightly less expensive
The cost of converting an existing vehicle is typically $17,000 to $45,000.
These staggering prices result in a huge majority of wheelchair users challenged with searching for public and private transportation accommodations.
Bus Barriers
The Americans with Disabilities Act (ADA) of 1990 guaranteed equal access and opportunity in transportation for individuals with disabilities. That meant public transportation like buses had to accommodate wheelchairs, but even 35 years later, problems with this provision persist.
Many buses, trains and subways lack essential features like ramps, lifts, and adequate space for wheelchairs, despite legislation requiring transit companies to have these features.
Likewise, many stops and stations lack curb-cuts or functional elevators to access platforms or bridges despite legislation requiring local municipalities to ensure transit stops have these features.
Lifts and other accessibility features on transit vehicles are frequently out of order, especially in rural areas with poor funding. More than one-quarter of the rail stations in the US remain inaccessible to wheelchair users as well.
Legislation unfortunately relies on individual complaints and litigation to drive compliance.
What You Can Do:
Tell your city to do better. Voice your concerns at public meetings which provide valuable opportunities to review and comment on a transit system's accessibility plan. Attending public hearings of your local transportation authorities and city council gives you a platform to share your personal experiences and concerns directly with decision-makers.
Tell your local transportation providers to do better. Request specific improvements and address examples of barriers you've encountered.
Tell your state and local legislators to do better. Point to the need for more funding for accessible public and paratransit systems for people with disabilities.
If you believe you have been discriminated against, consider filing a complaint with the Department of Transportation.
Rideshare Inequity
Per the ADA in addition to public transportation like city buses, subways, and light rail systems, private transportation like taxis, airport shuttles and hotel shuttles offered to the public must offer accessible options too.
Paratransit services (door-to-door transportation for individuals with disabilities) are allegedly guaranteed for people with disabilities who can’t use the fixed-route bus system. But many wheelchair users still report challenges accessing paratransit available to the public.
Public transportation options like rideshare companies such as Uber and Lyft only offer wheelchair accessible services in larger metropolitan areas, leaving out wheelchair users in smaller towns and rural regions.
Even where available, paratransit services may have restrictions on availability or require advance booking. They often involve longer wait times and unreliable service compared to standard options.
Rideshare companies face a significant challenge in increasing the number of wheelchair-accessible vehicles (WAVS) to adequately serve wheelchair users.
Disability advocates suggest companies should offer higher pay per trip for WAV drivers to offset the increased vehicle costs, or collaborate with government agencies and disability organizations to provide vehicle subsidies or grants for drivers interested in purchasing or converting vehicles to be wheelchair accessible. Most importantly these rideshare companies need to allocate resources for a larger fleet of WAVs in more regions, addressing current geographical limitations.
A lack of WAVs isn’t the only failure of rideshare companies. Recently the Department of Justice has moved to sue Uber over the many complaints passengers file after drivers refuse to allow manual wheelchairs to be stowed in trunks of their regular vehicles, as well as deny accommodation to passengers traveling with service animals. Uber responded by insisting their drivers do not discriminate, but the paper trail reveals a different story.
What You Can Do:
Tell Uber and Lyft or other rideshare options to do better. Provide feedback on their apps regarding accessibility and experiences.
Support advocacy efforts of organizations like the National Aging and Disability Transportation Center (NADTC) and the Accessible Transportation Resource Center (ATRC). You can potentially get involved or support their initiatives through their websites.
Tell your representatives to do better. Advocating for policy changes at the local, state, or even national level can encourage greater investment in accessible transportation.
Insurance Inefficiency
Wheelchair users utilizing non emergency medical transportation (NEMT) services through health insurance including Medicare and Medicaid also experience issues getting rides to medical appointments, though the service is relied on by 3 to 4 million beneficiaries.
Original Medicare (Parts A & B) does not cover routine transportation to doctor's appointments. Medicare Advantage plans may offer more extensive NEMT benefits but coverage varies significantly by plan. Medicaid is required by federal regulations to ensure necessary transportation for beneficiaries to and from medical providers though. This includes NEMT services, but benefits vary by state and these services can be limited, especially in rural areas.
Inconsistent scheduling, poor coordination between providers and transportation services, and a lack of standardized practices are cited as contributing to logistical barriers. Beneficiaries also report customer service issues with NEMT services, including late arrivals or no-shows, leading to missed or rescheduled appointments.
NEMT programs, particularly under Medicaid, can be underfunded, which restricts their reach and effectiveness. Transportation insecurity disproportionately impacts Medicaid and Medicare recipients, who are more likely to miss appointments.
Delayed access to necessary healthcare services and medications can worsen health conditions and increase healthcare costs. Missed diagnosis and treatment can be dangerous and even fatal.
To address inaccessibility of NEMT, advocates suggest Medicaid should further standardize and streamline how states administer services, and Medicare should offer more robust NEMT services.
What You Can Do:
Tell Medicaid to do better. Keep a detailed record of dates and times of appointments missed or where transport was inadequate. Document all communications with your health plan or transportation providers, including names of individuals you spoke with, what was discussed, and any resolutions promised or delivered. Keep copies of appointment confirmations, denials of transportation requests, or any other relevant documents. Ask your health plan for a concrete plan to resolve the transportation issues and meet your NEMT needs.
You can file a formal complaint (also known as a member grievance) with Medicaid if no reasonable concrete plan is offered.
Immediate Impacts
Adding a wheelchair to the mix complicates things. Some wheelchair users may be capable of transferring to a regular seat in vehicles that can accommodate standard folded wheelchairs in the trunk, but many wheelchair users lack mobility to lift and fold their manual wheelchairs, and many more, like myself, use power wheelchairs which are heavy, complex, and require a lift or ramp to enter a vehicle.
Health professionals point to the importance of avoiding social isolation experienced widely within the wheelchair community. The inability to travel independently can limit participation in community life, as well as prohibit getting out in nature, leading to depression, diminished self worth and perceived life quality.
Transportation inequality leads to income inequality too. Many wheelchair users who would love to work cannot do so because of the challenge of the commute. This difficulty or impossibility of reliably commuting to work significantly hinders employment prospects.
Accessing Equity
Some grants for personal wheelchair accessible vehicles are offered and sometimes state vocational rehab programs will pay for a vehicle conversion if they determine personal transportation will increase likelihood of becoming hired and staying employed. You can apply at your local Department of Economic Security.
Despite laws like the ADA requiring accessible transportation, enforcement is often insufficient, leading to non-compliance.
Enforcement mechanisms in place only focus on meeting the minimum requirements of the ADA, and political priorities can limit ADA in practice too. Decisions are determined by dollars- or political motives, while educational resources needed for planning, community engagement, and infrastructure design are often lacking, according to transportation industry workers.
That’s why as wheelchair users we can’t keep waiting for change. Transportation is vitally important for quality of life. It plays a role huge role in overall health outcomes too. Advocates point out the need for expansion of services covered by Medicaid and Medicare, to address broader social determinants of health too, like transportation to grocery stores or even work.
My injury should not sentence me to social isolation. Americans with disabilities should be protected by the ADA. And that includes transportation accommodations.
Transit agencies, rideshare companies, and city governing authorities must all be held accountable for failures to ensure transportation is accessible for everyone.
Tell them to do better.
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Additional Information
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