Curt Wolff was 55 when he contracted West Nile from a mosquito bite and became paralyzed.
“We didn't even realize this was a side effect that could happen,” Wolff said at his home recently. “The good news is I can feel everything. I can flex and move things, but the large muscle groups won't move.”
Wolff, who once owned a handyman franchise, has a bit of movement in his hands and spends much of his day in a wheelchair. He relies on home care, a team of people who come to his house in Thornton.
That care is covered by Medicaid. They help with activities of daily living, like transfers to and from bed, dressing, bathing, and toileting.
“Seven days a week. Someone gets me out of bed, gets me dressed, range of motion, feeds me breakfast, all the way to shaving me,” Wolff said.
Wolff is an accomplished bowler and runs a company that makes parts for a wheelchair bowling system. “I live pretty independent considering my level of injury. I'm pretty dang healthy,” he said. “I can advocate for people, I can work in the community, run my own business and live a pretty normal life.”
Wolff said the life he leads is possible thanks to the Medicaid Buy-In for Working Adults with Disabilities program. It's part of an optional service offered when Medicaid expanded more than a decade ago. It allows working people with disabilities who make under a certain amount of money to buy into Medicaid to get the care they need.
That program could now be in peril as Republicans in Congress and the White House are working to broadly reshape the federal government. Coloradans, like Wolff, are watching closely and anxiously.
Wolff said he doesn't have the money to pay for those services on his own, so this care would go away.
“It'd be gone. A 100 percent would be gone,” he said.
His significant other, Carole Johnson, said without the program, Wolff would be in a nursing home, the type of facility that can’t provide his current level of care.
She said the program is a matter of survival for Wolff.
“Curtis has survived 12 wonderful years, unfortunately in the condition he's in, but has survived. He wouldn't have survived in a nursing home this long at all,” Johnson said.
If Congressional Republicans make deep Medicaid cuts, it’s unlikely Colorado would have funds to make up the difference.
Wolff said he remembers campaign promises by the president to cut wasteful spending but not specifically to Medicaid, or this program. He urges Washington to think carefully.
“Where do you cut? Do you cut to the quick? Are you cut til it bleeds? That's too far. You have to make smart decisions,” he said. “It's just a giant pyramid of effect that if this goes away, it's going to be a huge negative effect. So I don't want to throw a scare out there, but yeah, I'm concerned about it not just for myself, just for the economy and everyone in general.”
Congress is weighing $880 billion of Medicaid cuts in the budget resolution that the House passed a few weeks ago. Also being considered, trillions of dollars in tax cuts. Many programs, including the Buy-In for Working Adults with Disabilities, are at risk if they move ahead with deep cuts.
One expert with the Robert Wood Johnson Foundation told CPR if Colorado were to drop coverage for the people who got it in the Medicaid expansion, the estimate is about 230,000 people would become uninsured.
The health care of tens of thousands of people is at stake
Upward of 10,000 Coloradans rely on the program, said Hillary Jorgensen, co-executive director of the Colorado Cross-Disability Coalition.
“I don't know how many of them have the resources to pay for their care out of pocket.”
If the program were defunded, many would be scrambling to find alternative care or lose it altogether. She said the total cost of the program is about $238 million a year, with both state and federal government splitting the cost — so Colorado’s contribution is $119 million annually.
With Colorado’s Buy-In program being an optional Medicaid service, that makes it particularly at risk. Some budget proposals are eyeing cuts to funds used to expand the number of people covered by Medicaid, which happened after Obamacare, also known as the Affordable Care Act, was enacted.
Colorado currently pays for the program through the Hospital Provider Fee. Provider fees or taxes are on the list of things that Congress could eliminate. That would be in order to reach the $880 billion in cuts that the House of Representatives directed the House Energy and Commerce Committee to find. Colorado gets a federal match on these fees or taxes.
Colorado’s tax limiting law, TABOR, the Taxpayer Bill of Rights, is also a factor.
The law’s supporters contend it keeps taxes and state spending in check. But Jorgensen said it also limits Colorado’s options.
“We are in a uniquely bad situation in Colorado because of TABOR, which doesn't really allow for any budget flexibility or creative revenue opportunities,” she said. “This is both a national funding problem and a state constitution problem.”
The people who are currently using the Buy-In would not come off of the Medicaid rolls, Jorgensen said. Most people with disabilities now enrolled in the Buy-In program would spend their current assets down until they became poor enough to qualify for traditional Medicaid.
Thousands of disabled Coloradans could be forced out of work and back into poverty, she said.
“There is absolutely no way that the state would be able to backfill federal funding if Congress makes hundreds of billions of dollars worth of cuts to Medicaid, including provider fees and taxes,” Jorgensen said. “That's why our main focus right now is on fighting federal cuts. If those federal cuts can happen, legislators are going to have to make some pretty devastating decisions because the solutions they'll have in front of them will be limited by TABOR.”
