Republicans in the House of Representatives have released their framework for the cuts needed to renew the expiring 2017 Trump tax cuts and to fund the President’s domestic agenda. They need to do this without substantially increasing the country’s debt. That means they need to make some significant cuts in federal spending.
The process starts with leadership assigning cuts to specific House Committees. The Energy and Commerce Committee – which is responsible for Medicaid – has been charged with finding at least $880 billion worth of spending cuts over the next decade. If those cuts were all taken out of Medicaid, it would be a 10% cut to the program with potentially devastating consequences for the services people with disabilities need to survive.
In 2017, we led the successful fight to save Medicaid and Obamacare during #SummerOfADAPT. The 36 days of protests began on June 22nd – the anniversary of the Olmstead decision and ended when Senator McCain famously voted against the plan with a dramatic “thumb down.” These protests spanned the entire country, from Arizona to Alaska and Maine to Miami. Here are some key things we learned from that experience and our nearly 70 years of combined disability activism.
2025 is not 2017.
A lot has changed since 2017. Although some people would like to believe otherwise, Donald Trump was duly elected President, winning both the Electoral College and the popular vote. He not only maintained and mobilized his base, including those in rural communities and blue-collar workers, but he also expanded his support among younger, Black, and Hispanic voters. At the start of the Summer of ADAPT in 2017, President Trump’s approval rating was only 36%. The resistance was center stage. It was visceral and loud. Now, in his second term, CBS News reports that the President has a 53% approval rating. That number fluctuates but is still important. Perhaps, more importantly, Democrats were united in their resistance in 2017 but today struggle to find a voice of opposition.
Unlike 2017, Trump-world political strategist Steve Bannon has warned Congress about cutting Medicaid on his podcast, saying, “Medicaid, you gotta be careful. Because a lot of MAGAs are on Medicaid, I’m telling you. If you don’t think so, you are dead wrong.” President Trump, himself, has promised that Medicaid won’t be cut. In January, he said, “We’re not going to do anything with that, unless we find some abuse or waste. The people won’t be affected. It will only be more effective and better.” We wouldn’t bank on either of those statements to save Medicaid, but they give some insight into how we work.
The math says, “Focus on the House!”
Although Republicans have again secured the White House and have one-party control over the federal government, their margin in the House actually is smaller than the last Congress and is dramatically smaller than in 2017. The repeal of Obamacare and cuts to Medicaid were stopped in 2017 with the support of three Republican Senators. Today, it would take four Republican Senators to block a bill in the Senate. It would take just two Republicans in the House to stop a bill. That information is critical for our strategy.
Our advocacy to save Medicaid must be local.
Although the first action during the Summer of ADAPT on the anniversary of the Olmstead decision in 2017 was powerful, the individual actions all over the country – including in El Paso, TX and Norman, OK – underpinned our success. Stories in the local media and even letters to the editor have far more of an impact on members of Congress than national coverage. The public is also more likely to support an issue when they see the impact on local people.
When dealing with the Senate, we have an entire state to find constituents, but House districts are much smaller, and members listen to their constituents. Some staff in the House literally screen out people who aren’t from the member’s district. Advocates in every district need to start identifying local people now, and we need to pay particular attention to key Republican districts where there are a lot of Medicaid recipients or swing voters.
Solidarity does not mean uniformity.
Democrats have tended to use a top-down approach to strategy. Leadership would establish specific talking points that everyone was expected to use. In 2017, there was pressure for ADAPT to say exactly what others were saying, but that really wasn’t the right approach then, and it isn’t the right approach today. When we all use the same talking points, it makes it easier for our opposition to respond and counter the argument. When we collectively raise a barrage of different concerns, they need to respond to much more, and it is easier to overwhelm them. That’s exactly what the Trump administration is doing with the flood of executive orders and activities.
Be authentic.
Medicaid impacts many people’s lives in many different ways. The Obamacare expansion of Medicaid provides health insurance coverage for working-class Americans. Medicaid provides important healthcare services for children. Hospitals – which can be major employers – depend on Medicaid. Today, with the expansion of managed care, insurance companies also make a lot of money from Medicaid. Finally, Medicaid also funds the services and supports that allow Disabled people to live in freedom. It’s critical that we speak our own truths. It is particularly important for Disabled people to do this because we know that when cuts happen, they cut us first.
And be authentically Disabled.
What made the protest in Mitch McConnell’s office compelling was the image of Disabled people being dragged away. The protest was organized so that Disabled people – who could either with or without assistance – got out of their wheelchairs and were on the floor. Although it was described as a “die-in,” it had a much more practical purpose. We wanted to be removed slowly to give the media a chance to cover the action. The images, showing Disabled people being carried away, illustrated the issue and were compelling.
Even on a smaller scale, when an ADAPTer attended a local town hall and was speaking, the Representative said, “I can’t see you, please stand up.” Everyone in the room yelled, “She uses a wheelchair.” Someone added, “She doesn’t have any arms or legs.” It was embarrassing and a bit funny but resulted in securing a personal meeting with the representative. This means that your local group must include people with disabilities who rely on Medicaid services, including folks with significant disabilities. That may mean helping with transportation and attendant services to facilitate their participation.
Be visible and unexpected.
Show up at their local office or attend a local town hall. Raise the issue at other public meetings. Maybe you don’t have a local Congressional office, but you can take your message to the local town council and ask for their support. We need local people and constituents to talk about this.
Be relentless.
We didn’t save Medicaid and Obamacare with one protest. There were 39 days of protests with multiple actions happening across the country at the same time. Truthfully, it was exhausting. We crammed a lot of protests into those 39 days. As Disabled people, we have grit, and we will need to use it.
We need to fight for freedom… not just funding.
The narrative that Medicaid is rife with fraud has been perpetuated by both Republicans and Democrats. In New York, the Democratic Hochul administration has been funding a constant stream of television ads highlighting fraud in Medicaid as a serious concern. Sadly, even people using Medicaid may have harsh opinions about other people in the program. When we focus on Medicaid funding, we need to work against this inherent bias. That isn’t an issue when we focus on the impact of Medicaid on our lives. For Disabled people who use Long Term Services and Supports, Medicaid means liberty and freedom. We need to focus on that.
There are three other reasons this fight is not about funding but about freedom. First, Medicaid funds some things Disabled people don’t want, such as institutionalization. Saving funding for nursing facilities will not motivate Disabled people to put our bodies on the line. Second, if we don’t make the case for our own freedom – and the freedom of other Disabled people, no one else will. And third, it is a message that works with Republicans. In fact, 16 Republicans supported legislation advancing Disability Freedom (appropriately named the Latonya Reeves Freedom Act) during the last Congress.
A strong offense is the best defense.
More than a million Disabled people are locked away in institutions solely because they have a disability. Our lack of collective and explicit outrage has been interpreted as a tacit agreement that some people with significant disabilities or a lack of informal supports need to be locked away from society. The question for policymakers becomes where to draw the line that determines those who are worthy of freedom and those who get locked away. In 2017, we were already demanding freedom for ALL Disabled people, which gave us the power to protect Medicaid and Obamacare.
Stay on message.
When you engage a member of Congress you disagree with, it may feel good to argue about other issues, but you likely won’t get their support. Focus on the impact of the Medicaid cuts on you, other people with disabilities, and the people they represent in Congress. That doesn’t mean you can’t hold people accountable. Just have those fights during other protests.
Make it personal for them too.
Don’t talk about “Congress” and the “President” making these cuts. When speaking to members of Congress, their staff, or the media, talk about what your member of Congress can do to support the Disability Community in our fight to save Medicaid and secure Disability Freedom. Use their name and publicly urge them to help.
We need both inside and outside strategies.
We need advocates who can explain our message in the offices, but the power in the office comes from the people in the streets and halls – and that doesn’t mean holding a stern press conference or an Instagram-style protest. Political people only act when they feel the pressure to act.
Be prepared to go outside your comfort zone.
Don’t just pick one role. For some folks who are more comfortable in protest, realize that you may need to talk with a policymaker. For others, it means going out and protesting on the street with other Disabled people. There is no question that an in-person presence makes a difference. The members of Congress and the general public need to see us to understand the impact. Our physical presence demonstrates how important the issue is to us. It forces those that want to take our freedom to look us in the eye and say so. It allows them to feel our passion in a way that a computer screen and speakers simply does not convey. They need to deal with us as Disabled people and their discomfort is a powerful tool. And it reminds them we are human beings – something non-disabled folks periodically forget when they think of us as the reason for a budget shortfall. This doesn’t mean that people who are unable to do this are less important; it just acknowledges the difference in impact. For those that do the work, you may find yourself in uncomfortable situations – cold, wet, and hungry – but when this work is successful, it is never easy.
Understand the person whose support – and vote – you want.
In this polarized environment, people have stopped engaging with people they disagree with. It’s easier to click “unfriend” than seek understanding and identify common ground. To get the support of members of Congress, we need to understand what is important to them to make our case effectively. That doesn’t mean we change our message, but it may mean we tailor the message to the person we are talking to. We learned this from a Republican Congressman who was a champion for people with disabilities. He said, “We never say ‘fund a report,’ let’s say ‘publish a report’ instead.” In the end, it meant the same thing, but we learned the importance of how we say things.
Engage people instead of just enraging them, and “leave space for grace.”
Tone is everything. We need to be firm in our opposition to Medicaid cuts that hurt our community, but we still need to get the message across so that someone can hear it. That approach will vary based on circumstances and the people involved. How ADAPT approached an action in Little Rock was very different from the one in San Francisco.
That said, from the start, it was clear that Mitch McConnell would never be a “no vote” in 2017, so being dragged and carried out of his office on the anniversary of the Olmstead decision wouldn’t change anything. Direct action, however, gives people time to engage, make a connection, and personalize an issue for policymakers. The protesters who spent hours in McCain’s office deserve credit for securing that dramatic thumb-drop in DC.
Recognize that there will be cuts.
Individual legislators have only a certain amount of leverage in their caucus. As an example, in New York, where Democrats in the Legislature have generally supported people with disabilities, they have actively taken steps to devastate the Consumer Directed Personal Assistance Program in order to give 1199SEIU a platform to organize the attendants. In this case, the Republicans will fund those tax cuts. We need to minimize the harm they do.
Expect more from Democrats.
It has been generally recognized that the #SummerOfADAPT protests were the cornerstone of saving Obamacare in 2017. Because many of the activists who protested were Disabled people who escaped institutions or were at risk of being institutionalized, many of us believed the Disability Community had earned the right of our people to be treated as full citizens and be emancipated from institutions. We fully expected that Democrats would acknowledge our contribution to the progressive movement and FREE OUR PEOPLE. That didn’t happen.
Instead, it is our understanding that based on a directive from Democratic House Leadership, no Democrat in the House of Representatives was willing to reintroduce the Disability Integration Act in January 2019. That’s why it was introduced by Jim Sensenbrenner – a House Republican. Things haven’t changed with new leadership in the House. Staff for Democratic Minority Leader Jeffries have told ADAPT activists that – despite widespread support from rank-and-file Democrats – House caucus leadership will not support Disability Freedom or the Freedom Act.
As we mobilize Disabled people to support the progressive response to these cuts, helping to save healthcare for Americans and funding for provider agencies, we should also expect our community to be emancipated from institutions.
ADAPT
American Disabled for Attendant Programs Today