By James T. Brett

PAOH President’s Introduction: Jim Brett is a true lifelong champion for people with disabilities. He is the President and CEO of The New England Council, the nation’s oldest regional business association which he has led for almost 30 years.

He is a former member of the Massachusetts House of Representatives, having served for 15 years. During that time, he was chairman of several influential committees in the Massachusetts legislature. He has served for many years and led let the President’s Committee for People with Intellectual Disabilities (PCPID) and the National Council on Disability (NCD) for multiple Presidents. He is also the recipient of 19 honorary degrees and countless awards.

Helen Journal, People Advocating for Optimal Health (PAOH), and the American Academy of Developmental Medicine and Dentistry (AADMD) have honored Jim numerous times over the years and is grateful for his never-ending support.

We are proud to publish his recent editorial. -- Dr. Steve Perlman

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When The Americans with Disabilities Act was signed into law in 1990, it was the most comprehensive piece of legislation addressing equality in decades.

As we reflect on the 35th anniversary of its passage, it’s appropriate to consider the accomplishments of the ADA. We also need to acknowledge there is more work to be done to narrow gaps of inequality in many areas, such as healthcare.

A landmark law

When thinking about the ADA, accessibility is often top of mind. The law requires that public spaces, including buildings, transportation, schools, sidewalks and streets, parks and recreational areas, be made accessible for people with disabilities. Today, in many places in the country, it’s difficult to imagine a time when the community routinely faced obstacles to board a train, go to work, cross the street, or sit by the shore. While much work remains, the law has been transformative.

Prior to the ADA, people with disabilities were challenged to access meaningful employment. The ADA prohibits discrimination in the workplace and, in fact, requires employers to provide reasonable accommodations, such as access to the building or assistive technology to use a computer.

Life and work are not limited to brick-and-mortar settings. The ADA also requires access to digital information, such as websites and online programs. Many technological advancements help individuals with hearing or visual disabilities access and read information on the internet or initiate programs with voice commands. The ADA sets standards. Innovation continues.

Looking ahead

One of the biggest changes resulting from the ADA is a shift in how society perceives people with disabilities. Over the years there has been a real change in how people communicate, think about, and interact with people with disabilities.

After all, we are all part of the same community!

As we look to improve our national systems and programs and implement change in the months and years ahead, it’s clear it is time to move forward.

Now more than ever it’s important to ensure that as we advance, no one is left behind.

Consider the pillars underlying our quality of life—from housing, employment, educational opportunities, and medical care. We made improvements, but there is still work to do.

Despite our national leadership in healthcare, numerous studies have revealed the reality of healthcare inequity.

There are 44 million people, or 13.6% of the U.S. population, who are living with a disability (2023, Center for Research on Disability, Census Data, American Community Survey). Yet, many do not receive regular preventive healthcare or adequate attention to dental or chronic medical issues.

A lack of training for physicians in serving people with disabilities has been highlighted by numerous studies as a factor in health disparities for this community.

Access to quality healthcare is key to quality of life. As providers and stakeholders work to remove obstacles to healthcare, proposals have emerged to improve access for people with disabilities.

“In May, Representatives Seth Moulton (D-MA), Brian Fitzpatrick (R-PA), Debbie Dingell (D-MI), and Joseph Morelle (D-NY) introduced the Healthcare Extension and Accessibility for Developmentally Disabled and Underserved Population (HEADs UP) Act of 2025. The HEADs UP Act would designate people with intellectual and developmental disabilities (I/DD) as a Medically Underserved Population, opening up many government programs aimed at improving access to care and reducing health disparities.”

A new perspective

In recent months, a bipartisan bill was introduced to ensure people with disabilities have access to quality health care.

In May, Representatives Seth Moulton (D-MA), Brian Fitzpatrick (R-PA), Debbie Dingell (D-MI), and Joseph Morelle (D-NY) introduced the Healthcare Extension and Accessibility for Developmentally Disabled and Underserved Population (HEADs UP) Act of 2025. The HEADs UP Act would designate people with intellectual and developmental disabilities (I/DD) as a Medically Underserved Population, opening up many government programs aimed at improving access to care and reducing health disparities.

The bill sponsors noted in their announcement, “Compared to the nondisabled population, people with I/DD receive fewer preventative screenings and fewer dental hygiene services. They have higher rates of undiagnosed hearing and vision impairments, diabetes, arthritis, and cardiovascular disease.” Contributing to this challenge: a shortage of medical and dental providers able or willing to treat them, is cited.

With a MUP designation, people with I/DD may have access to expanded care. The designation focuses on increased training opportunities for providers, including grant funding for providers to serve people with I/DD, medical school tuition aid, continuing education grants, and other programs supporting education.

Education for providers

Education and training can make a difference.

Every year, some 53,000 healthcare providers graduate in the United States and the majority receive virtually no training in the skills necessary to care for and treat people with disabilities. (Source: Rick Rader, MD, President, American Association on Health and Disability, Director of the Morton J. Kent Habilitation Center, Orange Grove Center, Tennessee and Editor-in-chief of HELEN, The Journal of Human Exceptionality). A Surgeon General's Task Force concluded that in four years of medical school, the students receive less than 11 minutes of training about intellectual and developmental disabilities. (Source: “Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation,” Surgeon General Report, 2002).

The lack of formal training across the system makes it imperative that we require all 200 medical schools, 500 nurse practitioner programs and 300 physician assistant programs to ensure these future clinicians have the skills, confidence and experience to competently care for and treat the growing population of people with disabilities. It is noteworthy that these skills are not solely directed to patients with special needs but are appropriate and applicable to all patient populations.

Conclusion

We need to do more to ensure that people with disabilities are not left behind as we move forward. And we need to move forward together.

Signed into law by President George H.W. Bush, the ADA had solid bipartisan support. The law stands out as an example of the power of public policy to effect change and improve lives. It also represents the limitless possibilities of what Americans can accomplish by working together for a common goal that is larger than themselves.

About the Author

Reflections on the ADA: Decades of Change and Looking Ahead

The Ethical Algorithm: Navigating AI & its Applications in the Lives of People with IDD

A New Way to Age in Place: Dementia-Capable Group Homes for Adults with an Intellectual Disability