The World Health Organization estimates that there are 1.3 billion people who are disabled globally or nearly one in six of us. People living with disabilities tend to have shorter life spans, higher mortality rates, and confront health inequities in virtually every facet of their lives. More than 80% live in low- and middle-income countries, further exacerbating their conditions.
In 2023 the Pew Research Center estimated that there were 42.5 million Americans living with disabilities, while in mid-2024 the Centers for Disease Control and Prevention (CDC) released its updated Disability and Health Data System report which tallied 70 million Americans experienced some level of disability in 2022, likely made worse by Covid. Nearly 44% of Americans older than 65 years of age reported being disabled.
The Social Security Administration (SSA) has 14 broad categories of disability with detailed medical criteria for each impairment, including musculoskeletal, neurological and mental, cardiovascular, hematological, congenital, and oncological disorders. The Committee on the Rights of Persons with Disabilities considers those with disabilities to “have long-term physical, mental, intellectual or sensory impairment which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.” Many definitions of disability often turn on whether the individual is able to be employed.
Over the past half century or so numerous and foundational government support systems and safety nets have been created to assist those with disabilities. The SSA has two broad programs: the Social Security disability insurance program (8.7 million beneficiaries, $12.7 billion in payments in 2023) and the Supplemental Security Income program (7.4 million beneficiaries, $64,6 billion in payments).
In 1964 the American with Disabilities Act was passed to prevent discrimination across most aspects of public life (access to education, healthcare, employment, transportation, etc). Notwithstanding those assurances, many of these efforts may well find themselves in the crosshairs of the new Administration’s federal budget which could either be eliminated or severely underfunded.
No doubt there is a looming federal funding crisis that will squeeze funds from important social benefits in order to service the extraordinary debt balances. Most recent estimates are that the U.S. national debt is $36.2 trillion or $106k per person. Interestingly, the percent of U.S. debt to GDP has skyrocketed to be nearly 120% (left hand axis) while overall S&P 500 corporate debt levels have glided down to be a more manageable 10% of net debt to market capitalization.
Debt Levels
Source: Federal Reserve Bank, FactSet
While there is much consternation over the new Administration’s approach and budget priorities, the White House announcement late last week that the $557 billion of “nondefense discretionary spending” would be reduced by $163 billion in the 2026 budget (a 22.6% reduction from 2025 budget levels) sent tremors through the community advocating on behalf of the disabled. This category of spending includes funding for education, transportation, and public health. Federal funds are to be redeployed for enhanced boarder security and defense. Obviously, all initiatives that address issues of equity and inclusion, which often times directly benefit the disable, are being eliminated.
This reallocation of federal resources is historic, certainly when considering federal spending as a percentage of GDP. What makes this so jarring, in addition to the chaos and haste, is that this spending is for the direct benefit of American citizens, often those most in need without proper and vocal advocacy. These proposals strike many as punitive and, at times, somewhat arbitrary.
Nondefense Discretionary Spending as Percent of GDP
Source: Center for American Progress
Recently, the Labor Department released its Persons with a Disability labor report which showed that in 2024 the employment to total population percent was 22.7% for those with disabilities versus 65.5% for those without a disability. The disabled unemployment rate was 7.5% last year as compared to 3.8% for those without a disability. Disabled workers were twice as likely to be part-time and 9.2% identified as self-employed versus 6.0% for those without disabilities. Arguably, employment status for the disabled appears to be more precarious. Surprisingly, the April 2025 employment report registered a resilient 177k new jobs created and an unchanged overall unemployment rate of 4.2%, but is expected to weaken considerably over the next several months.
One of the more controversial elements of the Fair Labor Standards Act (1938) was the creation of Section 14 (c) certificates which allowed employers to compensate qualified disabled employees substantially below minimum wage. Proponents argued that such accommodations were efforts to more effectively “mainstream” disabled employees while not compelling employers to compensate disabled employees who were thought to be less productive. In mid-2024 these employees were earning on average $3.46/hour as compared to the federal minimum wage of $7.25. Labor Department data for 2023 and 2024 revealed that 10% of 14 (c) employees earned less than $1.00/hour. Even though the Biden Administration sought to eliminate this program, there were still nearly 40k such employees at the end of 2024.
Number of Disabled Employees Earning Less Than Minimum Wage
Source: Department of Labor
The National Disability Institute estimated in 2020 that the incremental cost per household with someone who is disabled was 28% greater (~$17.7k) than that of a household without a disabled resident. The CDC’s most recent although dated analysis from 2015 calculated that 36% of overall U.S. healthcare expenditures was “disability-associated,” which was a staggering $686 billion. The expense burden showed significant variance by state and was most expensive in the Northeast. Overall, the average expenditure per disabled person was $11.6k. Depending on the level of disability, the Federal Reserve estimates that the “earnings penalty” per household to be from 15% – 70%.
Disability-Associated Healthcare Expenditures per Capita
Source: Centers for Disease Control and Prevention
Additionally, the incremental disease burden on the disabled is significant. The direct and indirect costs are often quite evident, measurable, and addressable. More insidious are the hidden costs such as unspoken discrimination or unpaid work or job opportunities never afforded the disabled. The Federal Reserve estimates that these hidden costs may account for as much as 40% of the overall difference in earnings for households with and without a disabled resident.
Americans with Disabilities
Source: Centers for Disease Control and Prevention (Behavioral Risk Factor Surveillance)
Accessing healthcare for the disabled is challenging across all dimensions, clearly. As further evidence of that the Department of Justice just last week alleged that several national health insurers paid hundreds of millions of dollars in kick-backs to brokers to drive enrollment and to steer (presumably less profitable) disabled applicants away from their plans.
The promise of AI to meaningfully improve communication, access, and navigation of the world around disabled people is particularly compelling. A recent McKinsey Market Research report estimated that the 2023 market value of the DisabilityTech sector was $25 billion, increasing to $37 billion by 2029. The Howe Innovation Center at the Perkins School for the Blind has identified more than 1,500 companies that are developing products specifically for those with disabilities.
Remarkable.org, a leading incubator of companies in the DisabilityTech sector, worked with over 130 start-ups since its founding in 2016 and is currently supporting 57 start-ups. Industry estimates are that $4 billion has been invested in companies in the DisabilityTech sector, although that is likely over-stated. More broadly, Tracxn estimates that $9.6 billion has been invested privately in 1,120 companies globally in the Assistive Tech sector.
According to Access2Funding, an organization to assist disabled founders, an analysis of U.K. founders determined that disabled founders are 400 times less likely to successfully raise capital. To address that market need, there are now several venture capital firms dedicated to opportunities in the DisabilityTech sector such as Enable Ventures, Difference Partners, and K Ventures.
Since the dawn of civilization there have been 108 billion people. It is estimated that the amount of food required over the next 40 years will be equivalent to what was consumed over the past 8,000 years. The pace of technological advancements is accelerating at rates never seen before, much less contemplated, to support this growth. Coincident with these advances there is a dramatic growth in population. One can only hope that technology will enable the disable to function at comparable levels to others and enjoy all that life has to offer.
And if you squint below, BofA anticipates “Immortality” will be achieved the middle of this century…
Technology Advances over Time
Source: BofA Global Economics Research
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