There is one huge constituency being left out of the health care discussion: Americans with disabilities.

Many Americans who require the daily assistance of others to live in our homes and communities must turn to Medicaid for help covering the cost of that care.

But first we usually have to impoverish ourselves just to become eligible.

Then we may well find that Medicaid will pay for the assistance we need only if we enter a nursing home. Medicaid rules require states to pay for nursing home care but not for more humane community alternatives.

This monumental injustice in our health care system has cost millions of Americans with disabilities their life savings, their independence and even their lives. But none of the health care proposals on the table adequately address this unfair bias toward institutions and nursing homes in Medicaid rules.

Nor did President Obama’s recent speech on health care offer any reassurance on this score.

The proposals that came out the Senate Health, Education, Labor and Pensions Committee and the House Energy and Commerce Committee would create a new public long-term care option. Financed through voluntary payroll deductions, workers who paid into the pool for at least 60 months could receive a cash benefit to help them pay for the assistance they need to live in their communities should they become disabled.

This idea, conceived by the late Sen. Edward Kennedy, is innovative in that it takes some of the financial burden for long-term care off Medicaid. But because it is employment-based, it does nothing for people whose disabilities prevent them from working enough to qualify. So millions will still be left at the mercy of the same old brutal Medicaid system.

Obama made no mention of long-term care in his speech. Throughout the process, he has refused to take the lead in making sure low-income people with disabilities are not left stranded.

There can be no meaningful health care reform for people with disabilities and our families without Medicaid reform.

If you or a loved one is disabled, you should pressure Obama and Congress to address the concerns of the disabled—not neglect them.

Mike Ervin is a Chicago-based writer and a disability-rights activist with ADAPT (www.adapt.org). He can be reached at pmproj [at] progressive [dot] org.