Ableism isn’t just about individual prejudice; it’s embedded in the structures and systems that shape daily life. Systemic ableism refers to the policies, laws, and institutional norms that create barriers for disabled people, often prioritizing the needs and perspectives of non-disabled individuals. While many people assume that disability accommodations are widely available and protected under laws like the Americans with Disabilities Act (ADA), the reality is that these measures often fall short in practice, leaving many people with disabilities navigating an inaccessible world.

At Oregon Spinal Cord Injury Connection (OSCI), we work directly with individuals who experience these barriers daily. From healthcare to employment to public infrastructure, systemic ableism is a persistent issue that affects independence, well-being, and quality of life.

 

The Medical Model vs. A More Inclusive View of Health

One of the biggest examples of systemic ableism is the way our healthcare system defines “health” itself. The medical-industrial complex largely operates under the assumption that health means being able-bodied and fully functional, which ignores the reality that many people with disabilities can live healthy, fulfilling lives when they have the right support.

Take physical and occupational therapy, for instance. Many insurance policies only cover these services if a patient demonstrates “functional improvement.” This means that individuals with conditions that are not expected to improve—such as spinal cord injuries, progressive neurological disorders, or congenital disabilities—often struggle to access or maintain these essential therapies. The assumption that progress equals success ignores the importance of maintenance care and adaptive strategies that help people live independently.

Another example is the way Medicaid and Medicare approach complex rehabilitation technology (CRT), such as custom wheelchairs and adaptive equipment. Instead of ensuring that people receive the mobility devices that meet their needs, Centers for Medicare & Medicaid Services (CMS) policies often focus on preventing “waste, fraud, and abuse.” While preventing misuse of funds is important, these restrictive policies create real harm by denying people access to essential equipment. This approach does not align with broader civil rights laws, such as the ADA, which affirm the right of people with disabilities to full participation in society.

 

Economic Barriers and Eligibility Restrictions

Beyond healthcare, systemic ableism also manifests in economic policies. Many social safety net programs, such as Medicaid, Supplemental Security Income (SSI), and other disability benefits, impose strict income and asset limits. This means that disabled individuals who require these benefits must remain in poverty to qualify, discouraging financial independence and professional advancement.

For those who work while receiving disability benefits, even a modest increase in income can result in the loss of crucial medical care, personal assistance, or adaptive equipment. This creates a cycle where people with disabilities are forced to choose between financial stability and necessary support services. Oregon is no exception—these outdated policies continue to create economic barriers that disproportionately affect disabled individuals.

 

What Does Health Equity Look Like in Oregon?

Health equity means ensuring that every person has access to the care and support they need to thrive, regardless of ability. In Oregon, progress is being made to address systemic ableism through community-based health initiatives. One key strategy is hiring Community Health Workers (CHWs) as part of care teams.

CHWs play an essential role in advocating for people with disabilities, ensuring that healthcare providers understand and address accessibility barriers. By acting as liaisons between medical professionals and the community, CHWs help elevate the voices of disabled individuals and push for more inclusive policies.

​Systemic ableism often manifests in the lack of accessible resources and support for individuals with disabilities. To combat this, Oregon Spinal Cord Injury Connection (OSCI) has initiated the Wheelchair Maintenance Workshops (WMW), aiming to empower wheelchair users by providing essential tools and knowledge for maintaining their mobility devices. ​

These workshops, held in collaboration with community partners like Bike Farm in Portland and Talent Maker City in Talent, offer free sessions where participants can learn entry-level maintenance and repairs. The goal is to ensure that wheelchair users have the skills to keep their equipment in optimal condition, thereby enhancing safety and independence. ​

By addressing the practical challenges faced by wheelchair users, OSCI’s WMW directly confronts systemic barriers that often leave individuals without adequate support for equipment upkeep. This initiative not only promotes self-reliance but also fosters a supportive community where individuals can share experiences and solutions, effectively challenging the structures that perpetuate ableism.

 

How We Can Push for Change

Addressing systemic ableism requires action at multiple levels—from policy reform to community advocacy. Here are a few steps that individuals and organizations can take:

• Advocate for policy changes that prioritize the needs of disabled people, such as improving Medicaid eligibility rules and expanding access to CRT.
• Support disability-led organizations like OSCI that work directly with affected communities to push for systemic change.
• Challenge ableist assumptions in healthcare, workplaces, and public spaces by listening to and amplifying the experiences of disabled individuals.
• Promote universal design in public infrastructure, ensuring that accessibility is built into new projects from the start rather than treated as an afterthought.

 

Final Thoughts

Systemic ableism is deeply ingrained in our society, but that doesn’t mean it’s unchangeable. By recognizing these structural barriers and working to dismantle them, we can create a more equitable world where disabled people have the same opportunities and access as everyone else. It’s not just about compliance with laws—it’s about ensuring dignity, independence, and full participation in all aspects of life.

At OSCI, we’re committed to this work. Join us in advocating for a more inclusive future—because when we remove barriers for disabled individuals, we create a better world for everyone.