Join Us in the Continued Fight Against Cuts to Healthcare, Supports & Services

Join Disability Rights Education & Defense Fund (DREDF) in our continued efforts to ensure access to affordable healthcare, Medicaid, and supports and services needed to live in our communities, including housing. We are collecting stories to share as we meet with officials in Washington, DC, and in California, and to amplify on social media.

Participant information

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* 1. Name:

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* 2. Are you completing this form on your own or with consent-to assistance?

Self

with Assistance

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* 3. Email:

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* 4. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 5. Phone number:

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* 6. Where do you get your healthcare coverage? (mark all that apply)

Medicaid (Includes Medi-Cal, IHSS, etc.)

Medicare

Employer provided insurance

I am a disability rights advocate or ally

Other (please specify)

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* 7. Do you identify as disabled, Deaf, and/or chronically ill?

Yes

Not sure (please explain)

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* 8. Where do you get your healthcare coverage? (mark all that apply)

Medicaid (Includes Medi-Cal, IHSS, etc.)

Medicare

Employer provided insurance

I purchase health insurance on the ACA health insurance Marketplace (or Exchange). In California, it is called Covered California.

Other (please specify)

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* 9. Tell us about yourself. Include your age (if you'd like), race/ethnicity, pronouns, a brief description of your disability, and any equipment you use (like a wheelchair, ventilator, etc.).

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* 10. Do you experience barriers to health care, securing food, vaccine access, housing or other supports or services needed to live in your community? If so, what are they?

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* 11. If you purchase insurance on the exchange, have your premiums gone up? By how much? Do you rely on tax credits to make your plan affordable?

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* 12. What do you want Congress and decision makers to know about Medicaid, your health insurance, vaccines, SNAP, housing or other supports or services? What message do you have for those who are making cuts to critical programs?

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* 13. Do you have any questions or comments?

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* 14. How would you like to get involved? (mark all that apply)

I can make phone calls or write letters.

I am interested in rallies and events.

I can help with outreach.

I can share my story (go to Question 13)

Please specify.

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* 15. Share my story. DREDF participates in rallies and events like the past 60 Hour Protect Medicaid Vigil. During events, we read stories from people around the country about why Medicaid is important to them, including messages to Congress. We also submit stories to offices in Congress and the California state legislature that are fighting for our access to necessary supports and services like Medicaid, affordable healthcare, and housing. You can use the questions earlier in the survey as a guide for your story and include anything else you would want policymakers to hear. If there is not enough space, please email your story to media@dredf.org.

Join Us in the Continued Fight Against Cuts to Healthcare, Supports & Services

Question Title

* 1. Name:

Question Title

* 2. Are you completing this form on your own or with consent-to assistance?

Question Title

* 3. Email:

Question Title

* 4. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 5. Phone number:

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* 6. Where do you get your healthcare coverage? (mark all that apply)

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* 7. Do you identify as disabled, Deaf, and/or chronically ill?

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* 8. Where do you get your healthcare coverage? (mark all that apply)

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* 9. Tell us about yourself. Include your age (if you'd like), race/ethnicity, pronouns, a brief description of your disability, and any equipment you use (like a wheelchair, ventilator, etc.).

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* 10. Do you experience barriers to health care, securing food, vaccine access, housing or other supports or services needed to live in your community? If so, what are they?

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* 11. If you purchase insurance on the exchange, have your premiums gone up? By how much? Do you rely on tax credits to make your plan affordable?

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* 12. What do you want Congress and decision makers to know about Medicaid, your health insurance, vaccines, SNAP, housing or other supports or services? What message do you have for those who are making cuts to critical programs?

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* 13. Do you have any questions or comments?

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* 14. How would you like to get involved? (mark all that apply)

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* 16. How may we share your story? Disclaimer: Before we share your story with a congressional office or social media, we will contact you.

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* 17. Where can we share your story?