The Rising Cost of Access — and Who Pays for It
As tariffs and inflation drive up the cost of assistive tech and medical equipment, the burden isn’t disability — it’s navigating a system that was never designed to support us.
Welcome back to Curious Constructs, where I seek to understand and challenge the barriers that prevent us from bringing our full, authentic selves forward — whether those barriers are personal or systemic.
Rethink This: The Hidden Cost of Simply Existing
It’s not having a disability that makes life more expensive, it’s the world we’ve built around it.
From wheelchairs to assistive tech, medications to modified vehicles, almost everything that enables independence comes at a premium. And now, with tariffs looming, that premium will become even steeper.
As a blind person, I live with expenses most people never have to consider. I rely on a range of assistive tools — from smart tech to screen reader software — that might sound like luxuries to some but are essential for me. These tools break down barriers and make it possible for me to fully participate in and contribute to society.
That’s because our world isn’t built with disabled people in mind. Every part of our society presents barriers — whether it’s education, infrastructure, health care or employment. We rely on technology, services and people to bridge those gaps, but now even that bridge is under threat.
Rising prices and supply chain disruptions — driven by the Administration’s tariff policies — are making assistive technologies, services and tools even more expensive and unobtainable. And while inflation is hitting everyone, it doesn’t hit everyone equally. It’s not just the price of rent or groceries going up — it’s the price of access itself.
This is what’s often called the disability tax: the extra time, money and emotional labor it takes to simply exist in a world not designed for us. And now, tariffs are compounding that cost — making it harder to afford the very tools we need to navigate a world that already excludes us.
Accessibility shouldn’t be a privilege. But unless we address the ways economic policy intersects with disability, we risk pushing essential tools further out of reach — and making it even more difficult to access the spaces and systems that are central to daily life.
An Overlooked — and Disproportionate — Impact
President Trump’s continued global tariffs proposal threatens to raise prices not just on foreign goods, but on essential items like medical and assistive equipment.
Following Trump’s tariff announcement in April, Mother Jones reported that these broad tariffs could raise costs on durable medical equipment (DME) — things like wheelchairs, oxygen tanks, CPAP machines and in-home dialysis kits — much of which is manufactured or assembled abroad. In 2024 alone, the U.S. imported about $41 billion worth of medical devices — from many of the countries that have not yet agreed to the trade or economic terms Trump is demanding.
Even before the tariffs, households with a disabled adult need an estimated 28% more income to achieve the same standard of living as households without disabilities. That gap only stands to widen with these current policies.
These tariffs also may lead to higher out-of-pocket costs, lower reimbursement rates and greater difficulty replacing aging medical equipment. The failure to consider the consequences of trade deals and tariffs was something I regularly discussed during my tenure as U.S. Special Advisor on International Disability Rights. I raised the fact that trade negotiators usually don’t consider how their deals can increase costs and shift the burden onto their citizens with disabilities. I shared this concern with many Ministers of Trade, one of whom told me:
“In my thirty years in this field I have never thought about the intersection of disability and trade.”
That’s the problem.
Trade policies aren’t just about products — they shape who can contribute to the economy, who can start a business and who gets left behind.
A Medical and Economic Threat
These policies won’t just affect people who identify as disabled — they will reverberate across the entire healthcare system.
About 40% of all medical devices used in the U.S. are manufactured overseas, which means everyday products like glasses, hearing aids, contact lenses and glucose monitors will also face higher costs. These aren’t niche items — they are part of daily life for millions of Americans.
And for the 18 million Americans already living in pharmaceutical poverty — those unable to afford the prescriptions and medical products they need — these added price hikes could be devastating. People with disabilities already face disproportionate healthcare costs, so this is not just an inconvenience — it’s a threat to our independence, safety and survival.
While the tariffs are raising costs, the proposed GOP tax bill would simultaneously cut $625 billion from Medicaid and $500 billion from Medicare over the next decade.
This matters for the nearly 72 million Americans enrolled in Medicaid (including 15 million with disabilities), and the 68 million enrolled in Medicare (including 7.7 million people with disabilities under the age of 65). These cuts only further jeopardize access to essential care and medical equipment for millions of us.
A Call to Action
There are some groups rightly fighting for tariff exemptions for medical devices and pharmaceuticals — especially as supply chain interruptions threaten access to life-saving medications and essential medical supplies.
But I think it’s important to emphasize: Persons with disabilities are not just passive consumers of prescription drugs and medical devices. We are entrepreneurs, healthcare innovators and manufacturers who drive economic growth and create jobs. We are 1.8 million small business owners in the United States alone, many of us working in the very industries impacted most by these tariffs.
When policies raise the cost of access, they don’t just limit our independence — they stifle economic growth, innovation and job creation.
Fixing this starts with recognizing that disability must be part of every conversation about trade, tariffs and economic policy. Right now, economists and trade negotiators rarely consider disability — not as a variable, not as a perspective, not as a priority.
We need more research and more collaboration, but we also need disabled people at the table: small business owners, advocates and leaders who understand how these policies play out in real life.
Because the truth is, decisions about trade shape who gets to participate in the economy, and who gets left behind.
This isn’t just a U.S. issue, either. When platforms like the G7 or ASEAN meet, disability is still missing from the agenda — and that silence has global consequences.
If we really want to build an inclusive economy, then disability can't be an afterthought.
We must ask:
Who is being invited into the room?
And are those rooms even accessible?
Fashion with Fida: Accessible Packing
Welcome back to Fashion with Fida, where I share style tips from my mom, Fida, along with reflections and ideas about accessible, modest fashion that’s expressive and fully you.
As a blind person who is constantly traveling — especially when I was working at the State Department — accessibility really shapes how I pack. The key for me is keeping things super simple and organized. Here are some strategies I use to pack efficiently, professionally and practically:
Ironing is always a challenge for me, so I either get help from someone at home or try to buy clothes that don’t wrinkle easily. When I fold my clothes, I do it in a way that minimizes wrinkles.
I use packing cubes for socks and other small things. And I always bring a laundry bag to easily separate my worn clothes from clean ones.
I pack by outfit — I’ve gotten really good at fitting 10 outfits into a carry-on (I almost never check a bag) because I pre-plan everything: I pair a hijab with each blouse and tuck the hijab inside, so I know which one goes with each top. I keep the matching blouses and blazers together — so it’s all grouped in sections.
I also separate things by color: black underscarves for my hijabs, black socks — anything black all go in one section. Navy blue pieces go in another.
One side of my suitcase — the zip-up side — is for professional outfits. The other side is for pajamas, undergarments and casual clothes, organized accordingly.
With a little planning and the right system, packing becomes less of a chore and more of a confidence boost — helping me feel prepared, polished and fully myself wherever I go.
Further Reading, Deeper Thinking:
Here are some key reports and initiatives from advocates and organizations working to protect employment rights and access to medical equipment for people with disabilities — especially as global trade policies continue to evolve.
A 2023 report from the Center for Strategic and International Studies examines how trade agreements can better include people with disabilities and help create more job and business opportunities — and an overall more inclusive approach. Read the full report here.
Dr. Amrita Bahri is a leading researcher in the field of trade and disability, her work emphasizes the importance of disability inclusion in trade agreements and policies. She has authored studies on trade and disability, including a significant work launched in December 2022 that detailed the prevalence of disability provisions in Free Trade Agreements. Read it here.
The Lilac Review has released its final report, emphasizing the need to support and empower disabled entrepreneurs, who own a quarter of the UK’s small businesses. Learn more about their work to create a more inclusive economy here.
A new UN-led working group formed in 2024 aims to make global trade more inclusive for people with disabilities by promoting data-driven policy, better access to assistive tech and digital tools. Learn more about the initiative here.
The National Disability Rights Network works to protect and advance the civil and human rights of people with disabilities — including advocacy for access to assistive technology and employment opportunities. Read their statement about recent cuts to Medicaid and other essential programs here.
Until next week — let’s be curious about ourselves, each other and the narratives that shape us.
Warmly,
Sara
Sara Minkara is a world-renowned speaker and visionary who challenges traditional perspectives on leadership, disability, and human potential. As the former U.S. Special Advisor on International Disability Rights, she transformed how nations and international organizations approach diplomacy and leadership in disability-related issues. Her unique identity as a blind Muslim woman and Arab-American entrepreneur informs her experiences offering a fresh and powerful perspective on authenticity and leadership.