How to Save Medicaid Through Direct Action - Pacific Standard

How to Save Medicaid Through Direct Action

One disability rights group from Colorado offers a lesson in how to make your representatives listen.
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Director of the Office of Management and Budget Mick Mulvaney testifies during a House Budget Committee hearing concerning the Trump administration's fiscal year 2018 budget on May 24th, 2017, in Washington, D.C.

Director of the Office of Management and Budget Mick Mulvaney testifies during a House Budget Committee hearing concerning the Trump administration's fiscal year 2018 budget on May 24th, 2017, in Washington, D.C. 

The future of Medicaid may depend on the actions of a handful of moderate Republican senators who so far have been very cagey about their stance on the latest proposed health-care bill's most controversial issues, especially when it comes to Medicaid. Last week, over 300 activists from ADAPT, the direct action disability rights organization that we profiled back in March, stormed Washington, D.C., to protest the GOP's bill. Eighty-three were eventually arrested for chaining themselves to the White House fence (technically for blocking the sidewalk). The next day, they dispersed to find their representatives in Congress. One group, from Colorado, succeeded.

Cory Gardner (R-Colorado) was talking on the phone when a small group of ADAPTers from his state rolled up. He quickly hung up, focused on his constituents, and engaged in a substantive, five-minute conversation about Medicaid and disability supports and services. The exchange was captured on video and posted to social media. It's a model of good, frank engagement between voters and their elected officials, but it doesn't show Gardner taking a position on saving Medicaid.

As we reported at Pacific Standard months ago, and as confirmed by the recent Congressional Budget Office, the American Health Care Act strips around $834 billion from Medicaid by rolling back the Affordable Care Act's expansion of the entitlement, but also by imposing "per capita caps" on the states. For disabled Americans, this latter threat is especially scary. Per capita caps involve changing the funding mechanism from reimbursing a percentage of actual costs to arbitrarily setting limits for every state. This means that many states, particularly those (like Colorado) that can't swap new state dollars for lost federal funds, will run out of money and will be forced to ration care in ways that are not only inhumane, but often fiscally foolish. Medicaid law, for example, prioritizes nursing homes over community-based living, even though community-based living is often radically more affordable. Under per capita caps, many disabled individuals believe they will be forced to choose between incarceration in a medical facility or homelessness.

This brings us to senators like Cory Gardner. Gardner, along with fellow Republican Senators Lisa Murkowski of Alaska, Susan Collins of Maine, Dean Heller of Nevada, and a few others are being identified by disability advocates as the most persuadable when it comes to saving Medicaid. Colorado, for example, would lose 20 percent (about $15 billion over 10 years) of its Medicaid funding, resulting in higher costs for the state. It's bad for state fiscal health. It's worse for the disabled citizens of the state.

The encounter with Gardner happened because ADAPT is good at what it does. I spoke to Dawn Russell, who speaks to Gardner at the start of the video and seems to have been the first person to catch his attention. (Russell wants to stress that she was just one member of a big group from Colorado.) "I was lucky enough to be with ADAPT at the White House," Russell says. On the first day, she was arrested, fined, and released, and then joined a group of 30 ADAPT women who gathered outside Ivanka Trump's house to ask her to speak up for the rights of disabled women (she didn't). The next day, the group went looking for their elected leaders. They were just making their way from the House side to the Senate when they spotted Gardner. "It was supernatural. We just felt the urgency," she says, as she describes the group splitting to make their way to the senator by whatever accessible means they could find. By chance, Russell and her sister, streaming on Facebook Live, arrived first.

It's a form of protest judo, using disability-related stigma as a tool to effect social change to fight that stigma. 

One of the powerful things about ADAPT is that politicians who might otherwise brush off public encounters are sensitive about the optics of ignoring or mistreating people with disabilities. It's a form of protest judo, using disability-related stigma as a tool to effect social change to fight that stigma. You can see it in the video: The senator pretty quickly recognizes that he's going to have to talk to his constituents, hangs up the phone, and gamely rises to the issue. The ADAPTers are polite and informed. They have their Colorado-specific facts ready. Gardner (whose office did not respond to requests for comment on this story) talks about his parents' bad experiences in nursing homes as he sympathizes with these constituents' desire for independent living options. In the video, however, Gardner does not take any specific positions on the per capita issue, instead speaking vaguely about controlling costs.

His caution is understandable, if lamentable. The whole apparatus of the Trump administration is lined up to set vulnerable members of our society in opposition to those who don't yet consider themselves vulnerable. Trump's budget calls for another $600 billion in "per capita based" cuts to Medicaid above what the AHCA would do. When budget director Mick Mulvaney calls the proposal "taxpayer first," he's setting up a divide-and-conquer strategy: Why should you be paying for other people who don't earn their keep? It might well work. The GOP has has been using income tax (only one of many kinds of tax) as way of dividing makers vs. takers for years. What's more, the GOP's policymaking is specifically leveraging ableist stigma against disabled people, implying they are lazy and just need tough love to get off the government dole. In March, House Majority Leader Kevin McCarthy suggested that the ACA's expansion of Medicaid stripped federal dollars away from disabled white children and funneled them instead to adults who, McCarthy suggests, are probably faking. The recent budget cuts $64 billion from Social Security Disability Insurance on the principle, as Mulvaney said, that "999 people out of 1,000" people don't think SSDI is real Social Security. In other words, stigma drives policy.

The Trump budget is a work of fiction, but fiction has the power to shape our imaginations. Meanwhile, the very non-fictional AHCA legislation is moving its way through the Senate. Democrats will not be able to filibuster. Mitch McConnell is not even allowing Democrats into the room.

And so that means it's all up to people like Gardner, his colleagues, and the constituents who should be flooding their offices with calls. Hopefully, Gardner will remember the people he met on the steps of the Capitol building on a sunny day in May as he decides how to cast his vote.

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