As we begin 2017, despondency covers America's progressives like a dark and enervating fog. With good reason-these are going to be a hard four years, with a great deal of suffering to come. But perhaps the biggest legislative battle of the Trump administration is beginnning, and it's one Democrats can win, if they're smart about it.
As Republicans themselves are now realizing, it's easy to criticize a complex health-care law when the other party is getting blamed for everything anyone doesn't like about the system, but it's a lot harder to come up with an alternative that won't do real harm to at least some Americans. That's their dilemma, and it provides the opening Democrats need to kill the repeal of the Affordable Care Act.
There are only a tiny number of conservatives who actually care about health care at all as a policy issue; it was essentially foisted on them when Barack Obama and congressional Democrats finally succeeded in passing comprehensive reform in 2010 after decades of failure. Since Democrats did care about it, they had spent all that time thinking about the system and how they might like to change it, which included debating amongst themselves and arriving at something like an internal consensus about what compromises had to be made in order to arrive at a practical and politically achievable solution.
The average Republican congressman could tell you a dozen different changes he'd like to make to the tax code, but he and his colleagues haven't had that same internal discussion on health care. Which hasn't been a problem up until now, because he can just say to his constituents, "Obamacare is a disaster! We'll repeal it and replace it! With, you know, something terrific!" If asked to be specific, he'd say, "Um, patient centered, not Washington dictates ... uh ... freedom to buy across state lines ... uh ... did I mention freedom?" They haven't thought much about this issue, and they're now going to be made to defend both repeal and whatever their leaders come up with for a replacement. That's what makes them vulnerable.
It's one thing to keep people from getting something they don't already have, but taking away something people are benefiting from is much harder. Which is why, for instance, Republican governors in most of the South could refuse to accept the ACA's expansion of Medicaid without paying much of a political price; in Texas alone, over a million people could have gotten insurance courtesy of the federal government, but it was more important for Rick Perry and his successor Greg Abbott to give Barack Obama the finger. But now imagine you're a governor in a state that did accept the expansion, like Ohio. If the ACA is repealed, that would mean 714,000 Ohioans on Medicaid because of the expansion would lose their insurance. The news media will be filled with stories of the catastrophic effect it will have on their lives-particularly when people start literally dying, which they will. What was an abstraction will become very real.
That prospect ought to make Republican politicians very afraid.
So Democrats need to remember that the specific things the ACA does are extraordinarily popular-most of them garner about 80 percent support in polls. As Kevin Drum recently wrote, "Even Republicans like practically everything about Obamacare, including the taxes to pay for it. People like the subsidies; they like the exchanges; they like the out-of-pocket caps; they like the Medicaid expansion; they like the pre-existing conditions ban; and they like taxing the rich to fund it all. The only unpopular part of the whole law is the individual mandate." Up until now that got lost amid a haze of Republican scare-mongering (remember "death panels"?) and broad attacks on this vague thing called "Obamacare" that few people understand. But now, every one of those provisions is a weapon that can be wielded against any Republican thinking about supporting repeal.
Which points to a critical thing Democrats need to do now: confront Republican senators and congresspeople, at the local level, with calls and emails, and in person. Every time a member of Congress does a town meeting, he should be asked questions like: Why do you want to re-open the Medicare prescription drug "donut hole"? Why do you want to kick so many people in our state off their health coverage? Why do you want to take away the subsidies that make insurance affordable for so many people? Why do you want to bring back lifetime limits on coverage? Can you promise that under your plan, nobody who has coverage now will lose it? I'm not happy about my out-of-pocket costs, but all the Republican plans look like they'll increase my out of pocket costs-that's what you and your buddies call "skin in the game." Can you promise me that won't happen? I have a pre-existing condition, like most people I know. Right now I don't have to worry-insurance companies can't even ask about it, and they can't charge me more or cancel my coverage because of it. Your plan sounds like it's going to make my life a lot more complicated. Can you promise I won't get screwed over?
The fear of questions like those is what's now leading Republicans to make promises they can't keep. Kellyanne Conway says that "We don't want anyone who currently has insurance to not have insurance." Paul Ryan says, "We will give everyone access to affordable health-care coverage" so that "no one is left out in the cold" and "no one is worse off." But the actual Republican plans will throw millions off their coverage and make most Americans worse off.
If you want to confront your representatives, you need to be armed with the numbers. If you're looking for the number of people in your state who will lose coverage under repeal, here's a source. And here's a study from the Commonwealth Fund showing how many job losses repeal would mean in each state. For example, let's take Nevada, where Senator Dean Heller is up for re-election in 2018. If the ACA is repealed, 264,000 Nevadans will lose their health insurance, including 187,000 who benefited from the Medicaid expansion and 67,000 who receive substantial subsidies. The Commonwealth Fund estimates that repeal would cost Nevada 22,000 jobs. Senator Heller should be forced to justify those losses every time he talks to voters. He should be deluged with calls and letters from his constituents explaining to him how they feel about it. That will most certainly influence his thinking about this issue.
And keep in mind that Republicans' margin in the Senate is only 52-48, which means Democrats only need to frighten three Republican senators out of supporting repeal, and they'll win the battle. Cracks are already showing in Republicans ludicrous "repeal and delay" strategy; as Politico reported on Saturday, "At least a half-dozen GOP senators have now expressed public or private concerns about the party's current trajectory. Their worry: Republicans will be blamed for wreaking havoc on the health care system and causing people to lose their coverage without any assurance they have a superior-or any-plan of their own." But when they do come up with a replacement plan, it will without question provide Democrats all the ammunition they need to make clear how awful the effects will be on Americans' lives.
This is a battle that Democrats can absolutely win. Tens of millions of Americans are depending on them.
