Update: Since originally writing this article, a a shocking Bloomberg expose has come out that found Stephen Miller as the driving force behind this memo.
For most of the 20th century, mass institutionalization of disabled people was the default in America. If you had a physical, psychological, or intellectual disability, the state could — and often would — lock you in large, crowded asylums or state schools for the entirety of your life.
These facilities were rife with overcrowding and both physical and psychological abuse; state facilities built for 1,000 people instead held 4,000 to 5,000 people behind their decaying, concrete walls.
That era ended with the landmark 1999 Supreme Court decision Olmstead v. L.C, a case where it was ruled that the government forcing disabled people into institutions was unlawful discrimination under Title II of the 1990 Americans with Disabilities Act (ADA).
When it was affirmed by SCOTUS, it became the federal rule for people to reference.
This was only a fragment of that fight. One chapter in a book written in exhaustion, in grief, in blood, and in the slow accumulation of small wins paid for by people who would not live to see them.
But this week, on June 18th, 2026, just four days before the 27th anniversary of Olmstead, the Justice Department released a thirty-nine-page-memo calling to overturn it, by claiming it does not mean what every federal court for nearly three decades has said it does.
Olmstead did not reform everything in 1999, but it became the foundation for every reform that has happened since. Including the Ohio lawsuit that came 21 years later using Olmstead as the basis, that resulted in freeing 1,000 disabled people from facilities where they had been waiting an average of 13 years to go home. That was the work Olmstead made possible.
Now, the DOJ wants to get rid of it.
A memo is not a ruling. But this one came from the DOJ itself, and silence right now is the exact response they are hoping for. This is a litmus test, and how we respond is the answer. Speak up. Learn about it. Talk about it.
The timing of the anti-Olmstead memo is almost ominous, aligning suspiciously well with last July’s executive order, “Ending Crime and Disorder on American Streets,” a directive that pushes for the involuntary civil commitment of thousands of Americans, as well as NSPM-7, the executive memo that gives them cover to place normal dissenters under civil commitment.
A mandate of that scale requires massive physical infrastructure. The DOJ has already started writing the checks, up to $3 million per grant under the FY25 Public Safety and Mental Health Initiative, which pays and incentivizes states to build “crisis stabilization centers,” with “no refusal policies,” meaning police drop someone off & the center cannot turn them away.
And not everyone can be framed as having a psychological or mental disability. And for those that can’t, you need to look no further than the contractors of confinement, GEO Group and CoreCivic.
All together, GEO Group and CoreCivic run roughly 160 facilities that contain ~150,000 beds, and all of it’s paid for by us. ICE alone accounts for 48% of GEO Group’s revenue and 35% of CoreCivic’s. That is billions of dollars in income a year. After every immigrant has been ‘processed’ through, the cages will still be standing, and their pockets will still need filled.
Of note: Geo Group and CoreCivic both have an existing behavioral health specific infrastructure, and are both eligible to run these “crisis stabilization centers,” too.
Applications for the funding to create these institutions closed in April of this year. Two months later, the names of the recipients are still nowhere on the public record. I will be watching this one closely.
In this article, I will put all of the pieces on the table for you, and it’s up to you to decide what they add up to.
THE “OVERCONSUMPTION” OF HEALTHCARE IN AMERICA
I want to preface this by saying that, “overconsumption” is their word choice, not mine.
It comes from an excerpt of Project 2025, the seditious plan written years in advance for the Trump administration by the Heritage Foundation.
Their specific complaint being that health insurance, “induces overconsumption of health care,” and that Medicare and Medicaid are, “irrational reimbursement schemes.”
It’s vaguely written and uses phrasing that almost makes it sound reasonable.
Well, that is until you look at the data and see that disabled people are 10-15% of Medicaid enrollees, but account for ~40% of all spending.
Autistic children alone ‘cost’ the government billions, because Medicaid overwhelmingly pays for their care. The Trump administration repeatedly and explicitly refers to autism as an epidemic that destroys families and children.
They are not calling it that because they’re worried about autistic people.
‘Economic Researchers’ in suits sit in a room calculating the lifetime social cost of autism and put a $3.6 million price tag on each child. The head of HHS reverberates that to the rest of America. RFK Jr. said autistic kids, “will never pay taxes” and, “will never hold a job,” as if your value as a person ends the second you can’t work.
Honestly, the entire section on Health and Human Services reads like they care about improving patient access and affordability. Every single word in it was chosen to make sure it reads that way.
And as a registered nurse, I will be honest, a few of their ideas here are surprisingly good, like saying we should prevent drug companies from funding government research that decides whether their drugs get approved and sold to Americans.
It’s a real problem. When a pharmaceutical company pays for the study of its own drug, the answer is almost always yes. It’s called industry sponsorship bias, and that is exactly how OxyContin got marketed as non-addictive, lighting the flames of the opioid epidemic in America.
This idea did not survive the inauguration. Roughly 53% of Project 2025 was enacted by the end of 2025, and this was not part of it. In fact, they are doing the opposite, and pushing more research into the hands of private pharmaceutical companies, while simultaneously cutting NIH funding for unbiased research.
And I need to be blunt:
One good idea does not outweigh the heinous amount of frightening proposals and claims throughout the 920-page-document.
The entire HHS section opens with a very specific claim that white Americans have lost 7% of their expected lifespan. It blames abortion, LGBTQ+ identity, transgender people, and divorced mothers. And it explicitly names each of these groups as a threat to children and America.
A lot of people treat Project 2025 as old news, but it’s not, and doing that would be a mistake. Every maneuver, every bill, every single thing you see happening inside the United States government is to execute the exact goals written in that document.
TL;DR? Project 2025 is not good by any means.
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We need to talk about their plan to fix healthcare "overconsumption" in America, because the proposal we are allowed to read is worse when you scratch the surface.
The ‘fix’ they propose is to hand the health insurance market to private insurers instead, and push everyone into HSAs, which are savings accounts that let you set aside pre-tax money for medical costs, which only helps if you have money to set aside.
Many disabled people do not. They are not allowed to.
7.5 million people (including those disabled from birth and those who became that way later in life) rely on monthly SSI income from the Social Security Administration (SSA) to survive. For disabled people to get help, the government requires a disability, having limited assets, and being under the poverty line.
What the authors of Project 2025 did not consider (or maybe they did) is the fact that the HSA health insurance accounts that they’re pushing for every American — including the disabled — are quite literally an asset.
HSAs are for healthcare, but the IRS has a technicality that grants people the ability to pull the money out of them. The SSA makes decisions not based on what you actually do, but instead what you COULD.
Anything that can be turned into cash is counted against you, and with asset limit of only $2,000 total, and owning a small HSA puts you over SSA’s federally-mandated limit. This would make a disabled person lose the income that they need to survive.
The Big Beautiful Bill gutted Medicaid by a trillion dollars, 11.8 million Americans are losing coverage outright, another 3.1 million are losing their marketplace plans, and disabled people are already among the wreckage left behind.
These asset limits already prevent disabled people from getting married, saving money, investing, or even owning a home. Now they want to take away the, ‘luxury’ of…. having health insurance.
It Gets Worse.
Another thing to consider with the push away from Medicaid and towards private insurance companies is the fact that private health insurance is built to fix short-term problems, like an infection or a broken bone. It is not set up to pay for years of ongoing developmental support.
This is an ongoing problem.
In 2021, a father sued United Behavioral Health in Doe v. United Behavioral Health because the United Health plan that his employer bought refused to pay for therapies for his autistic son.
A 2020 report found that roughly 78% of UnitedHealthcare's business runs through self-funded plans, which is the legal arrangement giant corporations like Target and Walmart and even the ones that major hospital systems use, specifically, to avoid paying for state-mandated care like autism therapy. Therapies that are covered under Medicaid.
Just days before Trumps second inauguration, UnitedHealthcare donated $5 million to MAGA Inc., the primary super PAC supporting President Trump. This ‘donation’ was twenty-five times larger than any other contribution they’ve made. I don’t know about you, but this makes me look twice at how the DOJ has handled the Luigi Mangione case.
Oh, and in 2025, the IRS raised the maximum amount of funding people can put into these high-deductible HSA accounts. In fact, this something that United Healthcare, through their subsidiary Optum Bank, has utilized astronomically.
Yes, you read that correctly.
UnitedHealth Group owns the insurance company, the bank that holds the HSA, and the doctors, clinics, and pharmacies the HSA pays. The same company collects on the same dollar three or four times before it leaves your account. The doctor who decides what care you need works for them.
This is something that CVS Caremark, does, too.
Insurance companies call this vertical integration; it exists so they can profit significantly from the money you spend to stay alive.
The company that decides whether to cover it works for them. The pharmacy that decides what you pay works for them. The bank that holds the money you use to pay it works for them. Every decision about your care is made by someone whose job is to charge you more.
So, to the Heritage Foundation and everyone making their Project 2025 dreams come true in the government:
Expanding private insurance, slashing Medicaid, and pushing HSAs is not consumer focused healthcare access. It is bullshit.
The able-bodied stay insured, and your donors stay rich. The disabled get a benefit too small to live on, an asset cap too low to save out of, and a healthcare market run by the same companies who write your white papers.
Able bodied, employed, lucky. That’s your healthcare model. Everyone else gets a coffin and thoughts-and-prayers from whatever senator is on your payroll.
And as a nurse, I am so fucking sick of watching people suffer and die because of the choices of the wealthy whose only concern is to make more money, even though they have more money than they could spend in a hundred thousand lifetimes.
Your proposal for HSA accounts is a joke. You want patients to "save" for their insulin? They're choosing between rent and rationing meds, and your answer is open a savings account.
You call it consumer freedom—
I have seen first hand what your idea of “consumer freedom” looks like.
It looks like a 34 year old with multiple sclerosis losing her power wheelchair coverage. It looks like a diabetic amputee discharged to a homeless shelter because Medicaid wouldn't cover the rehabilitation bed. It looks like an autistic child stripped of speech therapy mid sentence, because the waiver waitlist in Texas is now fifteen years long and his family makes forty thousand dollars too much to qualify for what’s left.
That's a culling, let’s not pretend otherwise.
In the early ‘70’s I had a fella cutting my grass so I could give him some money. This was in Columbus, Ohio. He lived at a group home. He told me that when he was little they sent him to a place because he was “feeble minded” (his words). I thought he was fine. Thoughtful and kind. Thank you for writing this and reporting on the inhumane treatment of our most vulnerable.
But we can afford to give Israel money so that THEY can have healthcare, college, free abortions on demand - gtfooh