For 40 years in Marion County, Gia Deasy taught special education classes, then worked as the county special education director. She advocated for decades for federal laws to protect people with disabilities, once segregated in institutions.
Now, laws protect children who need accommodations at public schools like extra time for tests, access to braille and text-to-speech technology.
“It’s good for me to sit next to a kid that has a disability, and it’s good for a kid with a disability to be seated next to me,” Deasy said, “Because we’re all going to share this planet together.”
In West Virginia, groups with expertise have warned officials for years that schools are breaking disability law.
Without the oversight of the federal Department of Education, which disperses funding for schools with high rates of low-income students and those with disabilities, and works to ensure that equality laws are enforced through the Office of Special Education Programs, they say that problem would likely worsen.
Former President Donald Trump has said eliminating the Department of Education would be among his priorities, if he wins another term.
As Trump seeks a return to the White House, closing arguments have been highlighted by a Trump rally full of misogyny and racism, and continued disclosures from the Republican nominee’s one-time top advisers that Trump favors dictatorship and fascism. Democrat and Vice President Kamala Harris, is finishing her campaign by urging voters to reject division and fear, and promising to focus on the needs of average Americans.
In West Virginia, Trump remains immensely popular and polls show he is likely to take the state’s four electoral votes.
But children, seniors, and the nearly one-third of West Virginians who rely on Medicaid for health care, could face additional challenges if Trump wins another term.
Another Trump administration would exacerbate existing state crises, especially if receptive Republicans take control of the U.S. Congress, policy analysts predict.
In a state that is among the oldest and poorest, with the highest rate of people with disabilities and the unhealthiest population, West Virginians can’t afford for life to get harder.
Children
Trump said on the campaign trail that he wants to dismantle the Department of Education, a proposal which is also part of the Republican Party’s platform. Similar efforts have been unsuccessful in years past, but Republicans have shown a growing distaste for public schools.
Trump has also called for “universal school choice.” He would find a supportive audience from lawmakers in West Virginia, where the state led the nation in school choice by providing nearly $5,000 for each student not enrolled in public school. That money would normally have gone to West Virginia’s underfunded public schools.
And while stressed-out teachers leave those schools, and enrollment declines, the number of students with disabilities who require special education services at school is increasing. West Virginia’s charter schools are not required to accept students with disabilities.
In Marion County, Deasy worries about the transition away from public schools because teachers are the most frequent reporters of suspected abuse and neglect, and they can’t do that when kids are homeschooled.
Harris, who is for keeping the Department of Education in place, supports increased money for the federal programs that send money to schools serving more students from low-income families, and she supports Head Start.
Deasy noted that the Republican candidates have stated that top goals include jobs and workforce.
“Where’s the next working class coming from if students aren’t educated?” she said.
Seniors
Orion McClurg has a lot on her plate. She works as a barista in Tucker County, and she is taking college courses, helping her father with farm work and providing home services for seniors in the area.
She only charges what they can afford. In this close-knit area, people take care of their neighbors. McClurg’s only health care training is first-aid certification and previous work at a veterinary clinic.
She’s helped with cleaning, taken care of seniors after surgeries and driven them to medical appointments. McClurg watches for signs their health is declining – symptoms like falls, memory loss and bed sores. For those with farms, she also helps with their animals.
“Many families feel incredibly guilty or uncomfortable putting their loved ones into a nursing home and would much prefer home care if it was an option,” McClurg said.
Lower-income seniors with challenges like dementia or mobility can get limited in-home help in West Virginia, through a Medicaid-funded program.
But a 2022 Marshall University survey of senior centers found centers’ biggest staffing issue was finding in-home caregivers, due to low pay from the state, so more than 42% of these caregivers were family members.
A Bureau of Senior Services survey found that one-third of caregivers surveyed said they were financially struggling.
“A lot have quit their jobs in order to take care of a parent,” one survey respondent wrote.
Some seniors with disabilities who could live at home with help are being confined to nursing homes because of inadequate caregiver pay and turnover.
As he campaigns for votes, Trump says he will not cut Medicaid. But during his administration, he repeatedly proposed slashing Medicaid. Nearly one-third of people in West Virginia use the federally-funded program.
Meanwhile, Democratic nominee Vice President Kamala Harris has presented a plan that would require Medicare to pay for in-home care, which could expand in-home services to serve more seniors.
She has said the proposal would provide relief to unpaid family members caring for their older relatives and families spending tens of thousands of dollars to pay for relatives’ in-home help or nursing home stays. The expansion of Medicare services would also lessen the chances seniors would be forced to turn to nursing home care.
Harris plans to continue President Joe Biden’s work to reduce Medicare prescription costs by negotiating with drugmakers, and she has said savings from those negotiations could pay for the new program.
On the campaign trail, Trump has said he wouldn’t cut the government-run Medicare program. But during his administration, he repeatedly proposed cutting the Medicare program. His 2021 budget included approximately $500 billion in net Medicare spending reductions over ten years.
During his administration, he also promoted private Medicare Advantage plans.
Organizers said seniors are lured into these plans without realizing they are for-profit programs.
“There’s very little advertising for traditional Medicare, but they have all these celebrities pitching these Medicare Advantage programs,” said Dr. Kenneth Wright, of Physicians for a National Health Program.
Wright, who recently retired, said it was like “pulling teeth” to get Medicare Advantage plans to pay for inpatient care.
Mindy Salango, health care organizer for the West Virginia Citizen Action Group, said companies are too focused on profits. She fears the privatization of health care.
“People are suffering,” she said. “People are getting sicker, and people are potentially dying. However, for the insurance company, that just adds more to their bottom line.”
People struggling to make ends meet
In downtown Fairmont, outside of a walk-in center for people experiencing homelessness or mental health problems, people who work in addiction recovery services were recently handing out naloxone.
Volunteers there said they’d like to see Medicaid expand in the state and begin covering transportation to drug treatment and recovery residences. Right now, they have to make those trips on their own time with scarce public transportation.
“It’s time consuming, but that’s just what we do,” said Samantha Burgess, who works for Valley HealthCare System. “We do it because we have to have it.”
Trump’s executive branch would be more likely to approve state policies that result in fewer Medicaid dollars flowing to the state. His administration has pushed for grants that limit the number of Medicaid dollars a state can receive.
Trump’s policies would put another health program that disproportionately benefits West Virginians at risk: the Affordable Care Act.
During his administration in addition to proposed cuts for Medicaid, Trump supported overturning the Affordable Care Act, though he presented no replacement program. Medicaid recipients in the state include low-income people, older people with disabilities and pregnant people.
In 2014, the ACA expanded Medicaid eligibility to working families with incomes up to 138% of the federal poverty level (about $43,000 for a family of four). The Act let young people stay on their parents’ insurance to the age of 26 and prohibited denial of coverage to those with pre-existing conditions.
More than 50,000 people in West Virginia now have health insurance through the ACA marketplace following an 80% increase in enrollment between 2023 and 2024.
Rhonda Rogombé, health and safety net policy analyst at the West Virginia Center on Budget and Policy, noted that low-income adults who rely on Medicaid already face multiple problems accessing health care.
She said that sometimes those with low or no income can’t get to a doctor to diagnose them to show they have a disability, qualifying them for coverage, because the state lacks transportation, child care and enough health care providers.
And some providers don’t accept Medicaid patients because it pays medical professionals less than private insurance. Fewer Medicaid dollars flowing into the state could make that problem even worse.
Facing Medicaid reductions, the Department of Human Services could also choose to remove patients from the rolls or cut treatments and services.
And even with many people covered by Medicaid or the Affordable Care Act, it’s still hard to access many types of care across the state.
A Marion County nurse, Josh Roark said he plans to leave health care completely after dealing with a system more focused on profits and protecting providers from malpractice claims than providing effective care.
While working at a Monongalia County provider, he spent much of his time helping patients find specialized care or substance use disorder treatment while dealing with long waiting lists.
Roark noted that meanwhile, providers do have to accept some patients, including those covered by the state employee insurance provider, but not Medicare or Medicaid recipients.
“If you’re on welfare, or you’re homeless, what’s the first thing they ask you for after your birthday?” he said. “Your insurance card.”