The day after the 2016 election, the fate of the Affordable Care Act seemed certain. “There’s no question Obamacare is dead,” said Robert Laszewski, a health policy consultant. Wasn’t it obvious? The only thing that stood between Republicans and repealing Obamacare before was a Presidential signature. Now, they had it: Trump campaigned on a day-one “full repeal of Obamacare,” and Kellyanne Conway even floated the idea of a “special session” of Congress on Inauguration Day to do just that (nevermind that Congress was already in session).
Even as Trump seemed to backtrack on a full repeal, Mike Pence reassured the base that ending the healthcare law would be an “out of the gate” issue. Senator David Perdue of Georgia appeared on CNN to rub it in, saying they could end one of the fastest expansions of health insurance in history without compromising with Democrats. Who was going to stop them?
“I don’t have a lot of people in my district who are crying about the possibility of losing Obamacare,” said Rep. John Shimkus of Illinois at the time. “No one is banging on my door saying, ‘Save this program.’” Even though Obamacare had brought the uninsured rate to the lowest on record, its popularity never rose above 50 percent.
But then Trump tried to end it. By threatening to make the healthcare system explode, the Trump administration inspired people to become activists for Obamacare—and it is the most important thing that Trump did in 2017.
Though Obamacare grew in popularity, more importantly its supporters grew in passion as its fate fell into the hands of a man who believes health insurance costs $12 a year. “Historically, we had always seen an enthusiasm gap, where Republicans were much more likely to say very unfavorable and Democrats were more likely to say somewhat favorable,” explains Liz Hamel, director of the Kaiser Family Foundation’s Public Opinion and Survey Research team. “After the election, we saw that share of Democrats saying very favorable increasing to the extent that it erased the enthusiasm gap.”
Not only did many people, including the President, discover what they gained with Obamacare, but they learned how much they'd lose with the Republican replacement plans—24 million without health insurance under the first version of the American Health Care Act, roughly the same under the revised attempt. Suddenly, even the young and healthy had no choice but to learn what a CBO score was, and 82 million flashed back to the days before the ban on pre-existing conditions, wondering whether the Republican replacement plan would bankrupt them and their families for good.
Congress soon heard, loudly and often, from the people whose lives would be sacrificed at the altar of Trump, all for the grand purpose of deficit relief and tax cuts for the wealthy. Planned Parenthood volunteers made more than 200,000 phone calls; Indivisible, a progressive political group, organized protests at the offices of gettable vote Susan Collins, a senator from Maine, among many other actions. Housing Works, the Center for Popular Democracy, and other groups demonstrated in Senate offices, even after Trumpcare’s second failure. Timmy Morrison, a 6-year-old who depends on the ACA’s ban on lifetime coverage limits, and other members of the advocacy group Little Lobbyists demanded to be heard, too, on Capitol Hill. Members of ADAPT, a disability rights group, staged a die-in at Senate Majority Leader Mitch McConnell’s office and a sit-in at Colorado Senator Cory Gardner’s office, where nine were arrested.
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“This was an existential threat to our community,” says Gregg Beratan, an ADAPT activist and manager of government affairs at the Center for Disability Rights, emphasizing that many members of the disability community depend on Medicaid, which would be gutted by any Republican plan. “There was never a chance that ADAPT was going to take any of this as a foregone conclusion.”
And soon, wouldn’t you know it, Tom MacArthur of New Jersey—remember, the one who tried to make everything better by allowing higher premiums for people with pre-existing conditions?—was getting called an “idiot” at his town halls. And so were many, many, many, many, many lawmakers.
Strangely, Kansas Senator Jerry Moran was unable to calm his crowd with a plea to remember what’s really important to him: “There is not a hospital that I could find in Kansas that is financially better off as a result of the Affordable Care Act.” And Shimkus? The dude who said no one was banging on his door to save Obamacare made sure of that: He refused to hold any town halls at all.
There are many reasons the Republicans couldn’t repeal Obamacare in 2017. There was a fracture among poles of the party, one that thought the repeal bills went too far and one that felt they didn’t go far enough. And then there is Trump himself, who, for his part, seems to not-so-secretly support single-payer, universal health care—in 1999, he said so to Larry King; in his 2000 book, he wrote that “we must have universal healthcare”; in May, he praised Australia for their health system.
But much is owed to activists who were willing to confront the officials they had elected to office when those same officials threatened to take away their healthcare—even Thad Cochran’s office (R-MS) had to admit the great majority of his deep-red constituents called to oppose the Republican plan (by a score of 224-2), joining many Democrats.
Who knew all it would take to energize a right-to-health movement in the US would be Donald fucking Trump of all people promising to make the healthcare system explode? He still might, but now we know it won't happen without a fight.
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