Ableism goes beyond personal bias. It lives in the systems and structures that shape our daily lives. Systemic ableism includes policies, laws, and institutional norms that create barriers for disabled people. These systems often center non-disabled needs and perspectives. Many believe that laws like the Americans with Disabilities Act (ADA) ensure access. But in practice, accommodations often fall short. As a result, many disabled people still face an inaccessible world.

At Oregon Spinal Cord Injury Connection (OSCI), we work directly with people who face these barriers every day. They deal with challenges in healthcare, employment, and public spaces. Systemic ableism limits independence, harms well-being, and lowers quality of life.

 

The Medical Model vs. A More Inclusive View of Health

One major example of systemic ableism lies in how the healthcare system defines “health.” The medical-industrial complex often assumes that health means being able-bodied and fully functional. This view ignores the truth. Many disabled people live healthy, fulfilling lives when they get the right support.

Take physical and occupational therapy, for example. Many insurance plans only cover them if the patient shows “functional improvement.” This creates a problem for people with conditions that won’t improve, like spinal cord injuries, progressive disorders, or congenital disabilities. They often lose access to these essential therapies. Insurers assume that progress means success. This mindset overlooks the value of maintenance care and adaptive strategies that support independent living.

Another example is how Medicaid and Medicare handle complex rehabilitation technology (CRT), like custom wheelchairs and adaptive equipment. Instead of focusing on people’s needs, Centers for Medicare & Medicaid Services (CMS) policies aim to prevent “waste, fraud, and abuse.” Preventing misuse matters, but these strict rules often block access to essential equipment. As a result, people go without tools they need to live fully. This approach clashes with civil rights laws like the ADA, which protect the right to full participation in society.

 

Economic Barriers and Eligibility Restrictions

Systemic ableism shows up in economic policies too. Many safety net programs—like Medicaid, Supplemental Security Income (SSI), and disability benefits—set strict income and asset limits. These rules force disabled people to stay in poverty to qualify. They block financial independence and limit career growth.

People who work while receiving disability benefits face tough choices. Even a small income increase can take away vital medical care, personal assistance, or adaptive equipment. This traps people in a cycle. They must choose between financial stability and essential support. Oregon faces the same problem. Outdated policies still create economic barriers that hit disabled individuals hardest.

 

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 a key role in disability advocacy. They make sure healthcare providers see and address accessibility barriers. CHWs act as liaisons between medical teams and the community. They amplify the voices of disabled people and push for 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 happen through partnerships with groups like Bike Farm in Portland and Talent Maker City in Talent. They offer free sessions on basic maintenance and repairs. Participants learn how to care for their equipment. The goal is to help wheelchair users keep their gear in top shape. This improves safety and supports independence. ​

OSCI’s WMW tackles the real challenges wheelchair users face. It confronts systemic barriers that often leave people without support for equipment upkeep. This initiative builds self-reliance. It also creates a supportive community. People share experiences and solutions. Together, they push back against the systems that reinforce 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 runs deep in our society. But it isn’t unchangeable. We must recognize these barriers and work to break them down. This effort can build a fairer world. Disabled people should have equal opportunities and access. It’s more than following laws. It’s about ensuring dignity, independence, and full participation in 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.