Introduction

Over recent decades, there have been significant policy changes to address the low employment rate of disabled people in the United States (US).1 As with other liberal welfare states, such changes have been driven by government concerns with rapidly increasing expenditures on income support programmes. Concurrently, there has been increased recognition of the rights of disabled people. In attempts to reconcile these discourses, governments have turned to active social policies, encompassing the idea that rights come with responsibilities, in order to ‘activate’ people receiving various benefits and encourage labour market participation (Sainsbury, 2001; Humpage, 2007; Parker Harris et al, 2012). The right to access social security and social programmes has been replaced with the obligation to work and earn income as individuals are expected to meet their own needs (Gilbert, 2009). For disabled people in the US, the welfare-to-work agenda is a voluntary programme known as Ticket to Work (TTW). The voluntary nature of this programme is unique among liberal welfare states, which have typically introduced harsher reforms to welfare programmes for disabled people. In the US, disabled people have typically been treated as ‘deserving’ of welfare assistance. Moreover, healthcare coverage in the US has historically been tied to participation in the labour market (National Council on Disability, 2008). Many disabled people are forced to choose between employment in the labour market or the receipt of benefits, including healthcare, but having a low standard of living.

In 2010, the US adopted the Patient Protection and Affordable Care Act, commonly called the Affordable Care Act (ACA), which expanded access to healthcare services within the Medicaid programme and private insurance companies. The ACA has the potential to positively impact TTW to enable disabled people to participate in the labour market, and receive rights typically afforded on the basis of social citizenship. However, as argued in this chapter, there are several inherent flaws in the ACA's policy framework that limit its impact for disabled people.

Below, we describe the policy context in the US, focusing on neoliberal and rights discourses and their role in active citizenship. We analyse how these discourses have been applied in policy rhetoric of welfare and healthcare reform specific to the TTW and ACA. Finally, the interconnected impact of these reforms is explored, with emphasis placed on neoliberalism and rights within these reforms.