If Mitt Romney has made one promise during the campaign it is to improve employment. From his slogan—”Obama isn’t working”—to his stump speech, to his talking points in debates and press releases, Romney has made high unemployment his central attack on President Obama’s record. Even permanent Republican goals, such as rapacious extraction of our natural resources and lower marginal tax rates, have been reframed as pieces of Romney’s five-step plan to get the country working again.
But one of Romney’s central campaign pledges—to repeal Obamacare—would undermine employment for those who are most likely to be unemployed: people with disabilities. The rate of unemployment among disabled adults has remained stubbornly high, even since the 1990 Americans with Disabilities Act banned workplace discrimination against them. In September, according to the Bureau of Labor Statistics, the labor force participation rate among people with disabilities was  21.9 percent, compared to 69.3 percent among people without disabilities.
That is partly because our pre-Obamacare health insurance system makes it impossible for many people with disabilities to get a job. People with disabilities require comprehensive and continuous insurance coverage. If you are unemployed and impoverished, you qualify for Medicaid. If you get a job, your income will make you ineligible for Medicaid. But your job may not provide you with health insurance. Even if you get insurance, it may not cover services and medications you require. Or it may not cover pre-existing conditions. Or it may subject you to an annual or lifetime cap on coverage that you will exceed. Even if you have none of those problems, there may be an untenable three month waiting period for your insurance to kick in. “That’s a huge disincentive to working,” says James Weissman, general counsel of the United Spinal Association. “A person with disabilities on Medicaid doesn’t have any cap, lifetime or annual. A person on an employer’s plan, even if he’s covered right away and doesn’t have a waiting period, could still have an annual cap of $25,000.”
Obamacare will correct all of those problems. It will eliminate annual and lifetime caps on coverage, make it illegal to deny coverage of pre-existing conditions and require large employers to provide immediate coverage to new employees. (It will also expand Medicaid coverage to include some 17 million low-wage workers.)
“Obama preventing exclusions for pre-existing conditions in the Affordable Care Act—assuming we survive Romney’s attacks on it—has gone a long way towards reducing the disincentive for people with disabilities to get employment. Assuming that’s the case people will not be afraid of losing their Medicaid in going to work,” says Weissman.
There are other reasons to oppose Romney’s pledge to repeal Obamacare: It will steal insurance from millions to pad the reimbursement rates of Medicare Advantage–participating hospitals and insurers. But, ironically, it will also work at cross-purposes to Romney’s supposed number-one priority.
For more on the impact of Obamacare, check out "What the Affordable Care Act Would Mean for Transgender People ."