Democrats who have struggled for years to sell the public on the Affordable Care Act are now confronting a far more urgent task: mobilizing a political coalition to save it.
Even as the party reels from last month’s election defeat, members of Congress, operatives, and liberal allies have turned to plotting a campaign against repealing the law that, they hope, will rival the Tea Party uprising of 2009 that nearly scuttled its passage in the first place. A group of progressive advocacy groups will announce on Friday a coordinated effort to protect the beneficiaries of the Affordable Care Act and stop Republicans from repealing the law without first identifying a plan to replace it.
They don’t have much time to fight back. Republicans on Capitol Hill plan to set repeal of Obamacare in motion as soon as the new Congress opens in January, and both the House and Senate could vote to wind down the law immediately after President-elect Donald Trump takes the oath of office on the 20th.
The emerging strategy is centered around highlighting people who have benefited from the law and who would lose insurance coverage or key consumer protections if it goes away. “We have to lead with them and their stories,” said Jeremy Bird, a Democratic strategist who served in senior roles for both President Obama’s reelection campaign in 2012 and Hillary Clinton’s campaign this year. “This is about what Trump and the Republicans want to take away from working families across the country, and we have to make that very clear this is what we’re talking about.”
Organizers say they’ll announce details about the coalition on Friday, but the efforts could include rallies both in Washington and in the states and districts of Republican members of Congress. It might also involve television advertising, although Bird said the most important part of the drive would be mobilizing constituents—including Trump voters who would be negatively affected by repeal—on the ground across the country. “I think that’s more important than some barrage of national ads,” Bird said. “That strategy is not going to work anymore in the future. It’s got to be about grassroots organizing. It’s got to be about real people who are constituents of these folks making it known.”
Democrats know the health law won’t survive in its current form even if Republicans fail to repeal it in its entirety. But they believe they are now on stronger political footing in arguing against changes that will strip away benefits and cause widespread disruption to the health-care market than they were in trying to defend an enormous and complex law that voters never fully embraced. And while a recent poll found a plurality of respondents disapproved of Obamacare, just one in four wanted to fully repeal it.
“If you poll people right now on the Affordable Care Act, you get a mixed reaction,” said Representative Steve Israel, a New York Democrat who has led the party’s messaging strategy in the House. He’s retiring from Congress this month but said he plans to stay active in the political fight next year. “But if you poll people on the consumer benefits of the Affordable Care Act, they’re wildly popular. So the Republicans are jammed. They cannot repeal and replace Obamacare without taking away those consumer benefits. When they take away those consumer benefits, public opinion will turn drastically against them.”
Those consumer benefits include the ban on insurers discriminating based on pre-existing conditions or enacting lifetime coverage limits, and the requirement that plans allow adult children to stay on their parents’ coverage until they turn 26. Republicans, including Trump, have said they want to keep those elements in an eventual replacement bill, but health-industry officials say it is difficult if not impossible for insurers to be able to afford those guarantees without also maintaining the less popular provisions of Obamacare requiring individuals to purchase coverage and employers to provide it.
Democrats involved in the repeal fight say the party must heed the lessons not only of its past struggle to make the law popular but also of the recent election. They need a single, overarching message that doesn’t get bogged down in too many details or recitations of statistics. “Democrats and progressives will be at our weakest to the extent that we are doing ad hoc, one-off pushback and at our strongest when we have a cogent theme that spans issues,” said Adam Green, co-founder of the Progressive Change Campaign Committee. “And that theme will be that Donald Trump is betraying his own voters by siding with giant corporations against working-class people.”
He continued: “Applying that to Obamacare, if you come anywhere close to taking health care away from 20 million people or giving the insurance companies any kind of sweetheart deal, people in rural areas are not rooting for the insurance companies to rip them off or deny their family care. There will be that broader thematic messaging, not an in-the-weeds argument.”
Yet boiling the 2,000-page law down to a one-liner or two remains easier said than done, and in conversations with Democrats over the last several days, there appeared to be little consensus on which argument was strongest. While many lawmakers talk about the millions who could lose insurance, for example, Israel believes the consumer protections are a more potent talking point because they benefit a much greater number of people. Others want to highlight the return of the once-dreaded “donut hole” for seniors—a gap in Medicare coverage that forced many of them to pay high out-of-pocket costs for prescription drugs. And a number of Democrats seem to prefer to mobilize voters against GOP attempts to overhaul Medicare, a far more popular program that has been a successful wedge issue for the party in the past.
Politically, Democrats plan to pressure Republican senators they view as potentially persuadable. Those could include Susan Collins of Maine, Lamar Alexander of Tennessee, Dean Heller of Nevada, and Shelley Moore Capito of West Virginia. Republicans will hold a much slimmer majority in the Senate than in the House, and the defections of three or more senators would likely thwart a full repeal of the health law.
“Republicans in the House and in the Senate are going to have to take a deep breath and consider the incredibly damaging consequences of repealing the Affordable Care Act,” said Representative Chris Van Hollen, a Democrat who just won a Senate seat in Maryland and will lead the party’s campaign arm over the next two years. “I mean, they are firing with real bullets now. And you’re talking about the health security of over 22 million Americans,” he added, referring to the number of people estimated to have gained coverage through expanded Medicaid or the state and federal exchanges under the health law.
GOP leaders are planning to quickly pass legislation modeled on a bill that Obama vetoed last year, which would repeal most of the health law but delay its enactment by two or three years to give Republicans time to come up with a replacement. While the Affordable Care Act would stay on the books, industry officials say the mere passage of repeal legislation could destabilize the insurance market and threaten coverage for consumers. “It’s one thing to send something to the president’s desk when you know the president is going to veto it,” Van Hollen said. “It’s another thing altogether to destroy a good part of the health system without any replacement.”
For the coalition that will launch on Friday, the imperative is to convince Republicans that as much as they may want to get rid of Obamacare, a repeal-and-delay strategy will only backfire. “Ultimately, it’s also going to cause harm to those who are promoting the repeal, both the incoming Trump administration and congressional Republicans,” argued Ron Pollack, who as executive director of Families USA is helping lead the new group. “The health-care system will be in total disarray. It will be totally dysfunctional, and those who support the repeal, who are bringing about the dysfunction and disarray will in effect be the owners of that health-care system. And they will reap considerable disappointment of those who are very much harmed by that dysfunction and disarray.”
Supporters of the health law have already promoted a study released Wednesday by the Urban Institute finding that repeal of Obamacare would leave nearly 30 million uninsured immediately and could eventually cost 59 million their coverage—more than the number who were uninsured before the law passed in 2010. In this fight, Democrats are also relying on help from allies who were not always on their side during the campaign to enact the law: hospitals and health insurers. The two largest hospital trade associations wrote a letter earlier this week to congressional leaders and the Trump transition team warning of “an unprecedented public health crisis” if the Affordable Care Act is repealed before a replacement is ready. And Marilyn Tavenner, the president of America’s Health Insurance Plans, the insurance-industry trade group, urged Congress to fund “temporary, transitional programs” while Republicans come up with a new plan.
Republican leaders have promised, in the words of House Speaker Paul Ryan, “a reasonable transition so that people don’t have the rug pulled out from under them.” But they haven’t defined what that means, and the party remains divided on just how long that period should last. Democratic leaders in the Senate have vowed not to help Republicans find the 60 votes they’ll need to replace the law with something new if they repeal it on a partisan basis first. Indeed, the party might find that the best way to fight for Obamacare is to stay out of the GOP’s way. “Republicans are about to learn that there’s a big difference between being against something and being for something,” Israel said. “They’ve already stumbled out of the gate, and we should let them continue to stumble.”