In the run-up to President Trump’s reelection last November, Texas and 16 other states filed a lawsuit that disability advocates now say could upend one of the legal cornerstones of disability rights in the United States.
Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against people with disabilities in any setting that receives federal financial assistance, such as public schools and health care facilities. The law acted as the blueprint for the Americans with Disabilities Act in 1990, which paved the way for a better life for many people with disabilities.
“This is a set of standards that generations of disabled people and disabled children have relied on,” said Claudia Center, legal director of the Disability Rights Education & Defense Fund, a national nonprofit advocacy organization.
When Texas v. Becerra was filed last year, it rippled through disability circles but received scant public attention. The states’ attorneys general cited the Biden administration’s update to Section 504 last year — which added gender dysphoria as a protected disability — as the reason behind the lawsuit.
Fears about the ramifications of this lawsuit bloomed in February after the states filed an update. The filing was an attempt to clarify what the states were targeting, but legal experts worry that the lawsuit could undermine the broader law rather than excising a small piece of it. The worries have been spurred on by the Trump administration, which has explicitly targeted diversity, equity, inclusion and accessibility since taking office. Earlier this week, the administration rescinded guidance documents that help organizations interpret the ADA, removing documents that described employees wearing masks and their rights during the Covid-19 pandemic.
STAT spoke with Center, whose career as a lawyer predates the ADA, to talk about why the lawsuit has inspired protests, and how it could prove catastrophic for Americans with disabilities. One of the lawsuit’s key arguments centers around Congress’ spending clause, arguing that it is unconstitutional to use the governing body’s fiscal authority in this manner. The lawsuit, whether by design or accident, could torpedo the notion that the federal government can withhold funding to force institutions to secure rights for people with disabilities.
This interview has been edited for length and clarity.
What exactly is Section 504 of the Rehabilitation Act of 1973, and why does it matter for disabled people’s health care?
It says that entities — which could be states or local governments, it could be a private entity — that receive federal money may not discriminate against people with disabilities, that they have to follow the regulations that describe what disability discrimination is.
For Section 504 plans in health care: State Medicaid programs, state hospitals, local hospitals, local health care systems, private hospitals, and doctors all get federal financial assistance of some kind. Those entities also have to follow all those rules about including patients with disabilities, having accessible medical equipment, having accessible websites and captions and sign language interpreters, and provide services in the most integrated setting possible.
So what is Texas v. Becerra about?
The lawsuit claims that a set of regulations finalized in 2024 are unlawful and unconstitutional. The two things that states complain about include a passage in the preamble to the regulations about whether gender dysphoria might be a disability, and the regulation about providing services in the community, we call it the integration regulation or the Olmstead regulation. The claim is that Section 504 is unconstitutional under the spending clause, that the regulations are unconstitutional under the spending clause.
I was concerned and upset by the transphobia, but then you get past the anti-trans content, it goes into the integration mandate, so it seemed as though to me that they were kind of using anti-trans hatred to make this broader attack on civil rights for all disabled people, not just trans disabled people.
Why is the integration mandate so important?
The integration mandate is one of our foundational principles. I just think it’s foundational that we include people in our society, in our institutions. That’s like the first principle of the independent living movement and disability rights.
The integration mandate is the right for people with disabilities, including significant disabilities, people who need high levels of support, the right of people to live in the community with those supports. That means that states should be running their Medicaid programs in such a way that those services are readily available, and these states don’t want to do it.
They say we’re only concerned about this Medicaid integration issue and nobody else will be affected. I don’t know if it’s a lie, but it’s not true. If you get a court to agree with you that Section 504 is unconstitutional, that is a highway that will be used for all the requirements of 504. There are all kinds of requirements under Section 504 that govern how federally funded entities do things. If this one goes, they could all go.
So, you’re saying this case could act like a universal lock pick — if the court agrees, then it would be easier to strike down many laws backing disability rights.
Yes, I think that’s right.
In the original complaint, one of the section headers says, “Section 504 is Unconstitutional.” But in the update they say they “have never moved … the Court to declare … Section 504 of the Rehabilitation Act as unconstitutional.” What’s going on here?
The case is very confusing and difficult to understand, even for lawyers. The attorneys general are trying to mislead people on what they’re doing or maybe they really think it’s narrow, but it’s not narrow. They’re trying to say, “It’s only about gender dysphoria,” or more recently, they’re saying, “Oh, it’s only about how we design our Medicaid program.”
Let’s say the court agrees with them and the regulation is unconstitutional under the spending clause. That entire argument could be applied to anything else. Disability rights is organised around [the idea] that entities have to change how they do things. This type of radical challenge is novel.
What’s the spending clause?
The spending clause is this idea that Congress can link federal dollars to affirmative requirements. And obviously that is critical for disability rights because we need more than just “thou shalt not intentionally discriminate.” We need, “you need to build your buildings in an accessible way, you need to make your websites accessible, you need to have sign language and accessible equipment.”
Let’s say the court agreed with them and issued a rule that said, “OK, yeah, you can challenge anything under the spending clause of the Constitution other than vocational rehabilitation programs.” That means it’s open season. If the courts agree with that, then there’s no stopping any challenge. [They would say,] “We don’t want to make accessible websites. We don’t want to give sign language interpreters. We don’t wanna have 504 plans for schoolchildren.” There’s no way to limit it in the way that they’re saying because the same constitutional theory that they’re asking the court to endorse, that theory would apply across the board.
Is there no recourse for states who say they can’t accommodate these changes?
The way disability rights work in the regulations and the ADA is that there’s always a balancing. In Section 504, there’s already a defense of undue burden or fundamental alteration. In other words, there’s already a balancing that’s in that statute to take into account the cost or burden of doing something differently.
If states believe that they don’t have to follow the rules … they are saying we shouldn’t have to follow the rule at all, it’s unconstitutional, so it’s taking dynamite and blasting up the whole rule, the whole statute. I think they’re either being disingenuous or maybe they don’t understand what they’re doing.
That’s what they’re saying publicly is that we’re only going after this one piece of 504, and then, so I would say A, that’s not true because the exact same argument can be used for any of the requirements if the court agrees with you. And then B, even if that were true, that’s horrendous because the integration mandate is one of our foundational principles.
How did you first learn about Section 504?
When I was in law school in the late ’80s, early ’90s, the ADA had just been passed but it wasn’t yet effective. We watched a movie called “The Power of 504,” and I was really moved. I really started wrapping my mind around the core principles of disability rights and disability inclusion, which is that we need to change the world, change our structures, change our systems, change our programs to include disabled people, rather than expecting an individual disabled person to somehow change how they do things or somehow exit their disability to access our society.
What do you expect to happen with this case?
We don’t know. We’ll be watching very carefully the next joint status report due on April 21. We anticipate that the gender dysphoria piece of the case will essentially go away — not for a good reason, but because we anticipate that the leadership at HHS will say they repudiate the passage in the preamble about gender dysphoria.
STAT’s coverage of disability issues is supported by grants from Robert Wood Johnson Foundation and The Commonwealth Fund. Our financial supporters are not involved in any decisions about our journalism.