With just days to go before the U.S. Senate again takes up the health care bill, an alliance of activist groups, caregivers and people of all abilities is at center stage in Colorado.

The grim reaper called to Vivian Stovall.

She found him printed on a poster board, the sickle in his hand marked “Trumpcare,” a MAGA hat on his skull and one bony middle finger up.

“The first thing I saw was the middle finger,” the retiree explained. “Being my age, and a female, and an African-American and now disabled, I have gotten the middle finger many times.”

She spends most of her days as a kind of informal ambassador for elderly people and those with disabilities in a dozen apartment communities around Denver. On this burning hot Thursday morning, though, she was holding her grim poster with hundreds of people in the park beneath Sen. Cory Gardner’s Denver office.

With just days to go before the U.S. Senate reconvenes and likely takes up the health care bill again, an alliance of activist groups, caregivers and people of all abilities is at center stage in Colorado.

The Republican proposals could reduce benefits for people with low incomes and result in higher costs for the elderly. In the past week, though, it’s been disability-rights activists who have most publicly pressured Gardner, one of about two dozen Republican senators who haven’t committed on the proposal.

Last week, images of people in wheelchairs occupying Gardner’s office lobby in Denver — on the fifth floor above the site of Thursday’s protest — rippled across the national media, with one video reaching 4.4 million viewers. On Thursday, the crowd tried to keep that momentum going as the Senate prepares to again take up the bill next week.

“Medicaid is liberty for people with disability,” one chant declared.

“Do you like what we’re doing?” a man asked passersby.

At age 35, this was Branden’s first protest, he said. He had come with SustainAbility, one of many Medicaid-funded services that brought clients to the event.

“I got Medicaid,” Branden explained. He didn’t know exactly how, but he knew that changes could be looming for the company where he works on recycling projects three days a week.

“It would be devastating,” said Melisa Kraai co-owner of the Arvada-based company.

“It pays for people to have support in the workplace. It pays for people to have therapy. These cuts will translate literally into people becoming homeless and possibly even death. It’ll happen.”

How?

The effects on people with disabilities’ use of Medicaid aren’t clear cut — it’s more of a ripple effect from a few major changes in the Senate bill. Among the biggest: The federal government would no longer match state spending on Medicaid.

That gets at the conservative goal of reducing Medicaid spending, which has increased by about 10 percent per year for Colorado in recent years, among the highest rates in the country.

Instead of matching the state, the federal government would use a formula to provide a certain amount per person, or a per capita limit. The Congressional Budget Office expects that the Senate bill would reduce Medicaid spending by about 35 percent by 2036 compared to the current trajectory.

The Colorado Health Institute found that federal funding to Colorado could drop by $15 billion through 2030. With less money, the state would face hard decisions about which services to fund.

And while certain services are required — such as nursing homes for disabled people — the benefits that help people live in the community are optional for funding, and thus could be cut.

“When the cuts are made to Medicaid, we get cuts to our reimbursement rates and our ability to serve,” said Donna Thurston, director of day and employment services for the Laradon Hall Society, which offers community living, employment programs and other services for adults with developmental disabilities.

“We will be forced to go and die in nursing homes,” said Jose Torres-Vega.

As an immigrant, he was ineligible for Medicaid for years. Now, Medicaid pays for a nurse who helps him get to his job as an IT manager for the Colorado Cross-Disability Coalition. (He’s a Linux guy, he said.)

“She goes to the office with me, she takes me to the bathroom. She takes me back at night and helps me change, so I can sleep,” the Lowry resident said at Thursday’s protest.

And he fears that he wouldn’t be able to afford that service if it were dropped from Medicaid — which, again, is a potential indirect effect of restricted spending.

The changes “serve the purpose to shift cost from the federal government to the states,” said Adam Fox, director of strategic engagement for the Colorado Consumer Health Initiative.

“And there’s really not a way that Colorado, and most states, would be able to come up with the difference to continue to provider services for those people that need it.”

At the same time, the Senate bill repeals taxes on investment and for couples making more than $200,000, among other changes.

But where does Gardner stand?

Thursday’s protests brought taunts and jeers to the park beneath Gardner’s office.

“It’s a beautiful day to hear from our senator, isn’t it?” asked state Rep. Leslie Herod. “Mr. Cory? Are you up there?”

Then she laid into him and most of the Republican power structure, decrying everyone from Gardner up to President Donald Trump as “cowards.”

Gardner has said little about the bill.

He previously has “urged caution,” on the rollback of Medicaid funding for the expansion to low-income adults, and he took credit for “ensuring that children with disabilities or medically complex cases were exempt from a proposed limit on Medicaid spending,” as Mark Matthews reported.

But his overall stance remains an unknown. And even as Thursday’s protest dispersed, a new wave of protesters were once again attempting to occupy Gardner’s office. More arrests were expected.