Several components of the GOP plan are particularly worrisome to the disability community, but the proposal to roll back Medicaid may be the single biggest concern. The ACA's Medicaid expansion, which extended coverage to those making up to 133 percent of the poverty level in states that opted into the program, increased health insurance enrollment in America by more than 14 million, and eliminating it will plunge people off a health-care precipice.
The proposed system of "block grants" mean that individual states may run out of Medicaid funding before they've met the needs of their residents, likely triggering crackdowns on benefits eligibility as well as dreaded lifetime per-capita limits on recipients.
Namel Norris, a paraplegic gun violence survivor who performs with hip-hop group 4 Wheel City, lives in the Bronx and is eligible for Medicaid coverage to help him manage health care needs associated with his injury. "Every month and every day," he says, "I rely on Medicaid." He needs Medicaid-covered medical supplies to leave his house, he says, so without it, he'd be trapped.
Not having to worry about lifetime limits also enables his art, Norris says: Instead of being caught in a struggle to survive, he can focus on youth outreach and education and making music. It's hard to imagine doing that, he says, with threat of Medicaid being pulled out from under him. "My life would just change," Norris says. "Drastically."
Dominick Evans, a disabled filmmaker and activist, says he is particularly worried about what "drastic" might look like for disabled people who rely on Medicaid's Home and Community-Based Services program (HCBS). Disability activists have worked for decades to keep disabled people out of institutions, earning victories in the form of the Americans with Disabilities Act in 1990 and case law like 1999's Olmstead v L.C., which ruled that community-based services should be prioritized over institutionalization.