The Affordable Care Act, which ushered in the most significant changes to the US healthcare system in half a century, has been placed on life support. But the healthcare law is not dead yet, and Democrats are turning to the public to save it.
On Sunday, liberal groups joined congressional Democrats for a “day of action”, holding dozens of rallies across the country in a show of support for the law that has come to be known, both affectionately and disparagingly, as Obamacare.
“You look great from up here,” said Senator Bernie Sanders, marveling at the large turnout for the “Our First Stand” rally in Warren, Michigan, where the temperature hovered near freezing.
Republicans have spent years vowing to repeal the Affordable Care Act, President Obama’s signature legislative achievement that extended healthcare to an estimated 20 million people and dropped the number of the uninsured to a historic low.
But the law has been beset by problems, including premium increases and health insurance companies pulling out of government-run marketplaces.
“What we are saying to the Republicans: ‘If you want to improve the Affordable Care Act, let’s work together,’” said Sanders, who is playing a major role in the coordinated effort against its repeal.
“But if you think you’re simply going to throw millions off of health insurance, you’ve got another guess coming.”
Democrats have long struggled to market the 2,000-page law to the public. Many of its major provisions, such as banning insurers from discriminating against people with pre-existing conditions and allowing young people to stay on their parents’ health insurance until 26, are popular. But polling shows a majority of Americans disapprove of the law as a whole.
A January poll by the Kaiser Family Foundation, however, found that just one in five Americans support repealing the law while three-quarters either oppose repeal altogether or prefer to wait for details on its alternative.
President-elect Donald Trump and Republican leaders have said they will not repeal the law without a replacement plan but are divided on how to move forward. Democrats and their liberal allies see a chance to save the law.
“The fact is they’ve got the US House,”’ said Senator Debbie Stabenow, of Michigan, in front of her home crowd on Sunday, referring to Republicans. “They got the US Senate. They’re going to have the US presidency. If they want to rip healthcare apart, rip Medicare and Medicaid apart, they can do that.
“The only way that we stop this is with your voices and your energy.”
Democrats and activists have planned more action, said Ben Wikler, the Washington director of MoveOn.org, a progressive advocacy group involved in organizing support for the law. Such action will include protests, rallies and “call-in days” in which constituents, especially in Republican states, will flood politicians’ phone lines with demands to protect the law.
Activists are also targeting Trump’s choice for secretary of health and human services, Georgia representative Tom Price, a physician who is a staunch opponent of the ACA.
“Every day that Republicans haven’t repealed Obamacare is a day that we’re winning,” Wikler said.
Republicans control Congress and the White House, but they do not have the votes to simply eliminate the entire healthcare law. Instead, they are using a parliamentary maneuver, known as budget reconciliation, to hastily unwind key provisions.
The tactic, which Democrats used to pass the legislation in 2010, enables Republicans to move forward with a simple majority, rather than the 60-vote supermajority. Republicans hold 52 seats in the Senate.
Last week, Congress cleared a path to repeal the ACA, after House Republicans passed the budget measure in a largely party-line vote, overcoming protests from Democrats and some in their own party who raised concerns that the repeal process was moving ahead without a replacement blueprint in place.
The Senate passed the measure in the early hours of Thursday after a show of resistance by Democrats, who took turns defending the law in floor speeches that lasted through the night.
Now the burden is on Republicans to come up with a plan that offers broad coverage and controls costs. Trump has said he will replace Obamacare with “something terrific”, but Republicans have yet to form a consensus around an alternative plan, which will require votes from Senate Democrats to enact.
Trump and Republican leaders have said they expect the “repeal and replace” process – which Democrats have dubbed “repeal and delay” – to happen concurrently. But they have offered varying timelines of when this will take place.
Trump has said he expects the repeal to take place as early as next week with a consensus replacement plan being offered “most likely be on the same day or the same week, but probably, the same day, could be the same hour”. He promised during his campaign to repeal Obamacare “on day one”.
But a repeal of the law by 20 January, day one of Trump’s presidency, is highly unrealistic. What “something terrific” might be is dividing the party. His comments to the Washington Post this weekend, that he would like to see “insurance for everybody”, did not make the picture much clearer.
Though he provided few details, the president-elect said: “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
The House speaker, Paul Ryan, meanwhile, told reporters last week: “We’re not holding hard deadlines, only because we want to get it right.” He said the party would use their annual retreat at the end of the month to discuss how to repeal and replace the law.
The budget resolution was just a first step. In the coming weeks, four congressional committees will draft legislation to repeal the major provisions of the ACA. The legislation is expected to be introduced by 27 January, but the deadline is not binding and Republicans have signaled that it will not be met.
That bill will eventually be voted on by both chambers. It needs only a simple majority to be approved and is immune from a Democratic filibuster in the Senate. At that stage, the bill would go to the president for signature and Trump has indicated that he expects it to be accompanied by replacement legislation. That is no easy demand.
Democrats can hold up the replacement process. To pass a robust package, Republicans will have to win over enough Democrats to reach the 60 votes needed in the Senate. Democrats have shown no signs of cooperating.
“We’re willing to look at making it better but we sure as hell ain’t going to repeal it,” the minority leader, Senator Chuck Schumer, of New York, said at the Michigan rally on Sunday.
“And we’re certainly not going to repeal it when our friends there don’t even have a plan to replace it.”