The battle to destroy – or save – the Affordable Care Act is on now. If Republicans manage to swiftly repeal core parts of the law and fail to pass an adequate replacement, 30 million people will lose their health insurance, according to an Urban Institute analysis.
What can you do to protect the ACA’s hard-won benefits – 12 million people enrolled in health plans in the ACA marketplace, another 12 million insured via the law’s expansion of Medicaid? A lot, as it turns out.
Look what happened a few days ago, when the new House majority moved to gut the House ethics office. Representatives were flooded with angry phone calls from their constituents. In less than 24 hours, they backed down.
Republicans’ plan to gut the ACA – which they’ve put in motion this week – may very well be vulnerable to citizen action. In brief, here’s why.
The quest for ‘insta-repeal’ without replacement
To fully repeal the ACA, Republicans would need 60 votes in the Senate to overcome a Democratic filibuster. But legislation that directly affects the federal budget can be passed with a simple majority by a process known as “budget reconciliation.’
Republicans are preparing what they call a “repeal-and-delay” bill. It would repeal the ACA’s core benefits – subsidies to buy health plans and expanded access to Medicaid – and also the ACA’s taxes on wealthy individuals and healthcare industries that help fund those benefits. Repeal of the benefits would be delayed for two or more years, while Republicans allegedly craft a replacement, for which they’d need Democratic support. But the repeal of the taxes would probably take effect immediately, limiting the money to pay for an adequate replacement.
Republicans need just 51 votes to pass a repeal-and-delay bill. They have 52 senators, and Vice President Mike Pence would break a 50-50 tie in their favor. But … many Republican senators are queasy about passing an ACA repeal without simultaneously passing a replacement. At least ten have expressed reservations (more on that below). To get at least three of them to hold out for “no repeal without simultaneous replacement” should be an achievable goal for the law’s supporters.
The repeal battle begins this week, as Senate Republicans are trying to pass a budget resolution instructing various committees to write bills repealing key provisions of the ACA by late January. Democrats can attempt to stall this first step during a Senate process known as vote-a-rama, when senators can propose an unlimited number of amendments. Democrats can heighten Republican qualms by proposing amendments that highlight the ACA’s benefits and protections and the ill effects of repeal. Vote-a-rama is happening tonight (Wednesday).
The time for ordinary citizens to weigh in is now.
How to make a difference
The traditional means of influencing your senators and congressional reps – phone calls, letters (email or snail), demonstrations, speaking up at town halls – all work when done right. In this case, Democrats’ spines can be stiffened, and their desire to be seen as showing leadership in defense of the ACA stimulated. Republicans’ fear of being blamed for taking health insurance away from hundreds of thousands of their own constituents can be heightened.
If you can join a local citizens’ action group, the function of such groups is basically to multiply, coordinate and draw attention to these interventions. Depending on your time commitment, you can help plan such actions, or simply participate in them, knowing that they’ll have a concentrated impact.
In all forms of communication, any personal benefits you or those close to you have derived from the ACA (which may include coverage of adult children under age 26 on their parents’ plans, or reduction of out-of-pocket drug costs for Medicare beneficiaries as well as health insurance obtained in the ACA marketplace or via Medicaid) is worth citing. Also useful: facts about the ACA’s impact on your home state. These are summarized state-by-state by Families USA, one of the key advocacy groups fighting to save the ACA, here.
1. Call your senators and reps
A complete list of senators’ phone numbers is here. You can find your Congressional rep here, and his or her phone number here. When you call, you will speak to a staff member who will promise to relay your concerns to the senator or rep. And that’s not an empty promise.
Former congressional staffers and experienced activists advise that phone calls to a senator’s or rep’s office are the most effective ordinary form of constituent lobbying short of a face-to-face meeting. Constituent calls on either side of an issue are tallied – so they function sort of like super-votes. Calls also take up staffers’ time and skull space – and register with other staffers who see their colleagues engaged repeatedly on a particular issue.
In calls to Republican members, urge that they not repeal the ACA without simultaneously replacing it with a plan that will cover at least as many people. To Democrats, say that you want to see them doing everything in their power to defend the ACA and stave off a hasty repeal without replacement.
Don’t worry about not being an expert. No one on the other end is going to quiz you (except perhaps to ask for details if you have a personal story to tell). They’ll just listen, and record your “vote.”
2. Write an e-mail or snail-mail letter
The links to phone numbers above also include street addresses. For e-mail, Googling any senator or rep will quickly bring you to their website, where it’s easy to find a contact form.
Two notes about the contents of a letter to your senator in defense of the ACA:
- First, any personal experience of being helped by the law is valuable and should be included.
- Second, for Republicans in particular, the “ask” is not to leave the ACA in place, as none of them will cop to not wanting to repeal it. Rather, demand that they not repeal the law without simultaneously replacing it.
There are two reasons for this: First, repeal without replacement will be a genuine disaster – and they know it. Second, Republicans can’t write a replacement, because they can’t agree on one. Many if not most don’t want to spend the money that avoiding a dis-insuring of tens of millions would cost and are dying to repeal the taxes that fund ACA benefits. If they do write a replacement they will need Democrats’ support, and that would entail creating – or just rebranding – something very like the ACA.
A sample letter produced by Families USA keeps to the broad goal of protecting progress made under the ACA without specifying whether new legislation would constitute amendment or replacement, and so works for senators and reps of either party:
As your constituent, I ask you to protect the progress we’ve made under the Affordable Care Act in health care and coverage. Please insist on a plan that will assure we continue to have quality, affordable health insurance before agreeing to repeal the law.
Repealing the Affordable Care Act could harm millions, double the number of uninsured by 2019, and throw the U.S. health care system into disarray. It could take affordable health care coverage away from 30 million people, including children and working families covered under the ACA’s Medicaid expansion.
Your constituents deserve to know what is in a replacement plan and see proof that it will provide better, more affordable care, coverage, and consumer protections than the Affordable Care Act does BEFORE any repeal.
3. Share your story
Families USA is collecting testimonials from people who were helped by the law. Here’s how the group explains the uses for these stories:
The group “will match participants with opportunities to share their stories publicly. Opportunities may include: requests from the media, policymakers, and advocates; use in our online efforts; and use in our policy briefs.” Submit your story here.
Also collecting citizens’ stories is the Center for American Progress, a leading progressive policy institute You can contribute to their story bank.
4. Tap friends and family to reach GOP senators
As noted above, many Republican senators have publicly issued warnings about repealing the ACA without having a replacement in hand. Since Republicans’ majority is much larger in the House, the Senate is the focal point of efforts to preserve the ACA.
Think about who you know who’s a) likely to support the ACA and b) lives in a state with at least one Republican senator. (Here’s a complete list of senators in the just-convened 115th Congress.) Urge them to write or call – the links above supply the contact info.
Among those most likely to hold out against repeal-without-replacement are many of the 18 Republican senators representing states that enacted the ACA’s Medicaid expansion. Many of those states have reduced the ranks of their uninsured by nearly half – or more than half – since ACA expansion. Others recognize – and have publicly warned – that the private individual market for health insurance is likely to collapse if ACA repeal is passed without a replacement in hand.
Five Republican senators have offered an amendment to slow down the repeal schedule announced by leadership, delaying the target date for submission of repeal bills from late January to early March. The five are:
- Rob Portman, Ohio
- Susan Collins, Maine
- Bob Corker, Tennessee
- Bill Cassidy, Louisiana
- Lisa Murkowski, Alaska
Other Republican senators who have expressed qualms about repeal-and-delay include:
- John McCain, Arizona
- Lamar Alexander, Tennessee
- Ron Johnson, Wisconsin
- Tom Cotton, Arkansas
- Rand Paul, Kentucky
Eight of these ten are in states that have expanded Medicaid under the ACA.
While some in this group have intimated that they’ll vote for a repeal-and-delay bill if it comes to the floor, it’s also true that the larger the queasy contingent, the likelier it is that they will find strength in numbers – and that at least a subset will make a stand against insta-repeal.
5. Attend a rally or town hall
Bernie Sanders has teamed up with House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer to call for a national Day of Action on January 15 to protect the ACA, Medicaid and Medicare. Rallies are planned in some 25 locations. In coming months, elected officials and citizen groups will doubtless by hosting and planning many more such events.
The Tea Party protests against the ACA-in-progress at Town Hall meetings in the long hot summer of 2009 have become part of American political lore. What’s less well known is that progressive groups supporting health reform fought back, often with equal or superior manpower and local impact.
There was a massive coordinated effort led by Health Care for American Now (HCAN), an umbrella organization for groups committed to universal healthcare. Member groups’ ability to muster supporters provided vital support that kept many representatives and senators committed to passing the bill that became the ACA. Similar efforts are gearing up now. It’s important to participate.
Richard Kirsch, who headed HCAN during the effort to pass the ACA, recounts in his book Fighting for Our Health incident after incident in which HCAN member groups provided crucial support when it counted. Here’s one:
SEIU’s North Carolina Director Dana Cope reported that most of the 800 people in attendance at the Durham town hall supported reform. “Congressman Price wouldn’t stop thanking us. It got lots of positive publicity for him. It emboldened him; he had a meeting, and lo and behold, people supported reform! He found out that it’s OK to vote for this – people want it.”
6. Use social media if you’re into it
Every senator has a Facebook page – just punch the name into the Facebook search box. Look for an ACA-related post to comment on. You can also monitor their comments on Twitter – and respond by respectfully urging them to #ProtectOurCare (a hashtag that will lead other supporters to second the motion). You can “stream” the tweets of Republican senators only by following this list.
Any and all Republican senators are worth contacting with a “no repeal without delay” message. Taking away constituents’ existing benefits is not in senators’ job description. Almost none of them want to do it, though they have almost all promised to in some form. Those who have expressed doubts include some of the hardest core conservatives (Cotton, Paul).
Some may stealthily work against a swift repeal even if they’re publicly for it. Some may also work to mitigate the effects if it does pass – for example, by delaying repeal of the taxes along with the benefits. If that happens, the ACA may in effect be “renewed” indefinitely.
Remember – just three Republican senators are needed to kill passage via reconciliation. It’s also possible that the “queasies” will insist that repeal of key features such as taxes that the fund benefits or the individual mandate be delayed along with the premium subsidies and Medicaid expansion – and that the hard-core right wing may then in turn balk, on grounds that the bill is a “repeal” only in name.
By hook or crook, supporters of the law should be able to help Democrats in Congress find a way to preserve the vast improvement the ACA has wrought in millions of Americans’ lives.
Andrew Sprung is a freelance writer who blogs about politics and policy, particularly health care policy, at xpostfactoid. His articles about the rollout of the Affordable Care Act have appeared in The Atlantic and The New Republic. He is the winner of the National Institute of Health Care Management’s 2016 Digital Media Award.