Energized by Republican moves to roll back the Affordable Care Act, leading patient advocates, consumer groups, labor unions and Democratic officials are mobilizing a nationwide campaign to defend the law and protect millions of Americans who depend on the law and other government health programs.
The campaign, which is quickly ramping up ahead of President-elect Donald Trump’s inauguration next week, aims to reshape the debate over the law after years in which the public conversation has been dominated by its critics.
But Obamacare supporters believe that as Republicans push to gut the 6-year-old law, Americans, including many who voted for Trump, will come to appreciate its protections and fight to keep them.
“This is real, and it affects everyone’s lives. … That is what’s different, when the conversation shifts from the rhetoric to reality.”
Already, there are signs of this new dynamic, as a growing number of Republicans voice concerns about rushing to repeal Obamacare without first outlining a replacement, something the GOP has yet to do.
Polls show thin support for the Republican strategy to repeal now but delay a replacement. No major organizations representing patients, physicians, hospitals or others in the nation’s healthcare system back the GOP approach.
And Trump enters office with historically low public confidence, a weakness that Obamacare defenders figure to exploit.
Democratic senators kept up the pressure Monday, taking to the Senate floor and using Facebook to challenge the Republican repeal effort. In a play on Trump’s signature campaign line, Democrats promise that the GOP strategy would “make America sick again.”
Activists planned a national effort Tuesday to get Americans to call members of Congress and urge them to vote against legislation that would roll back the law.
“This is as important to us as a presidential campaign,” said Mary Kay Henry, president of Service Employees International Union, whose 2-million members played a central role in helping pass Obamacare and are expected to be critical in defending it.
The order is daunting.
Republicans, who will control both the White House and Congress for the first time in more than decade, credit their victories in part to a relentless campaign against Obamacare.
And with some Americans struggling with large insurance premiums, GOP lawmakers have had no trouble finding horror stories to bolster their repeal effort.
“Obamacare is ripping apart at the seams, and things are only getting worse,” Rep. Diane Black (R-Tenn.) said in the party’s weekly radio address. The Tennessee insurance market has experienced some of the worst turmoil in the country over the last year.
At the same time, Democrats have taken a hands-off approach to the law in recent years, wary of being linked to its struggles.
But as this new chapter in the healthcare debate begins, they have some key advantages.
“Democrats who were always a little squirrely on robustly defending the Affordable Care Act are on very firm ground in fighting repeal,” said Sen. Christopher S. Murphy (D-Conn.).
Though public opinion about Obamacare is still split, most provisions of the law are extremely popular, even with Republican voters. That may fuel a major backlash if the GOP moves to take them away.
Eight in 10 Americans in another poll say they like provisions in the law that eliminate out-of-pocket costs for many preventive services such as cancer screenings or provide federal aid to states so they can expand Medicaid coverage for poor patients.
The same strong majority supports the law’s system of insurance marketplaces – such as HealthCare.gov – in which people who don’t get coverage through an employer can shop for health plans.
And 80% of Americans favor the government subsidies provided through the law to help low- and moderate-income people buy insurance.
GOP leaders have called for major cutbacks in Medicaid and a fundamental change in insurance rules that would guarantee coverage only for people who didn’t have gaps in coverage. Republicans also would no longer require insurers to offer basic benefits.
Democrats plan to prominently feature people who stand to lose some of these protections if the law is scrapped.
"When most people, even if they’re not Obama supporters, hear Natoma’s story or the stories of other people who have been helped, they know it’s wrong to just take away their healthcare," Obama said. "And it becomes less about who’s winning here in Washington. It becomes about how are we doing right by our fellow Americans."
At a meeting with congressional Democrats last week, the president encouraged lawmakers to look at the successful approach the nascent tea party movement took in 2009 and 2010 against Obamacare — including flooding lawmakers’ town hall meetings in their districts.
Also aiding the Obamacare defense could be in the GOP’s interest to make broader changes to other popular safety net programs, including Medicaid and Medicare.
Medicare provides coverage to more than 50-million elderly and disabled Americans. And Medicaid covers more than 70 million poor children, adults and seniors, many of whom depend on the program for nursing home coverage.
Leading Republicans – including House Speaker Paul Ryan (R-Wis.) and Rep. Tom Price (R-Ga.), Trump’s pick to be health secretary – have advocated major cuts in the programs that probably would slash coverage for the poor and shift more healthcare costs onto seniors.
“This is not just about the Affordable Care Act,” said Richard Kirsch, former national campaign manager of Health Care for America Now, a coalition of liberal grass-roots groups that played a pivotal role in helping pass Obamacare in 2009 and 2010.
“They are talking about replacing Medicare, cutting funding for Medicaid. … This would be devastating to affordability and accessibility of healthcare for millions of Americans, and we are going to be making it clear that this is one big attack on people’s health.”
Kirsch is helping restart the campaign, which has already organized demonstrations in 19 states.
On Capitol Hill, Rep. Eric Swalwell (D-Dublin), who is leading messaging efforts for younger voters on Obamacare, said the fate of the entitlement programs will also figure prominently in Democratic lawmakers’ efforts.
"More than ever, the family’s income is tied together," he said, summarizing the message as: “Don't end my mom’s Medicare. Don’t take my dad’s healthcare. … If our parents’ healthcare security is in jeopardy, the whole family’s financial security is in jeopardy.”