The Affordable Care Act is STILL under attack

Today, as the Affordable Care Act turns 7 years old, Republicans in Congress will be voting to repeal it. Not because the law does not make great strides in delivering on its promise of providing affordable care to all Americans but because it does deliver on that promise – the number of uninsured Americans is at an all-time low. Without the ACA, 36,000 people a year would die from treatable illnesses and thousands of families would be plunged into medical bankruptcy, forced to choose between caring for a loved one or paying the mortgage. The value of the social safety net has never been “settled law” in America and as long as Republicans are willing to put profits over people, tax cuts over children’s health, deficit reduction over common decency, Democrats will have to keep fighting with everything we have. We may not have political power right now but we have the power of the people behind us.

Here is a reminder of what happened seven years ago.

On March 23, 2010, President Barack Obama signed the Affordable Care Act into law. For over 60 years, Democrats had been trying to pass a law that finally and firmly declared that health care was a right and not a privilege.

This historic piece of legislation was possible because we had Democratic majorities in both houses of Congress and a Democratic president.

It is why Elections Matter … and why all the rest is noise.

On Behalf of My Mother:

Today, I’m signing this reform bill into law on behalf of my mother, who argued with insurance companies even as she battled cancer in her final days.

I’m signing it for Ryan Smith, who’s here today. He runs a small business with five employees. He’s trying to do the right thing, paying half the cost of coverage for his workers. This bill will help him afford that coverage.

I’m signing it for 11-year-old Marcelas Owens, who’s also here. (Applause.) Marcelas lost his mom to an illness. And she didn’t have insurance and couldn’t afford the care that she needed. So in her memory he has told her story across America so that no other children have to go through what his family has experienced. (Applause.)

I’m signing it for Natoma Canfield. Natoma had to give up her health coverage after her rates were jacked up by more than 40 percent. She was terrified that an illness would mean she’d lose the house that her parents built, so she gave up her insurance. Now she’s lying in a hospital bed, as we speak, faced with just such an illness, praying that she can somehow afford to get well without insurance. Natoma’s family is here today because Natoma can’t be. And her sister Connie is here. Connie, stand up. (Applause.)

I’m signing this bill for all the leaders who took up this cause through the generations — from Teddy Roosevelt to Franklin Roosevelt, from Harry Truman, to Lyndon Johnson, from Bill and Hillary Clinton, to one of the deans who’s been fighting this so long, John Dingell. (Applause.) To Senator Ted Kennedy. (Applause.) And it’s fitting that Ted’s widow, Vicki, is here — it’s fitting that Teddy’s widow, Vicki, is here; and his niece Caroline; his son Patrick, whose vote helped make this reform a reality. (Applause.)

I remember seeing Ted walk through that door in a summit in this room a year ago — one of his last public appearances. And it was hard for him to make it. But he was confident that we would do the right thing.

Our presence here today is remarkable and improbable. With all the punditry, all of the lobbying, all of the game-playing that passes for governing in Washington, it’s been easy at times to doubt our ability to do such a big thing, such a complicated thing; to wonder if there are limits to what we, as a people, can still achieve. It’s easy to succumb to the sense of cynicism about what’s possible in this country.

But today, we are affirming that essential truth -– a truth every generation is called to rediscover for itself –- that we are not a nation that scales back its aspirations. (Applause.) We are not a nation that falls prey to doubt or mistrust. We don’t fall prey to fear. We are not a nation that does what’s easy. That’s not who we are. That’s not how we got here.

And we have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care. (Applause.) And it is an extraordinary achievement that has happened because of all of you and all the advocates all across the country


That bill was passed by Democrats. Not “perfect Democrats”. Democrats. A group of men and women, many of whom put their jobs on the line (and lost them in 2010) because they believed in the core principles of the Democratic party.

Let’s stay strong and united against those who would take healthcare away from 24 million people. And let’s find a way to take back Congress to put up a firewall between those who want to destroy everything good about America and We The People.

When we vote, we win. And when we win, this becomes possible:

That looks pretty nice alongside these other reminders of why Elections Matter:



  1. Thread …

    • Andy Slavitt was the acting administrator for the Centers for Medicare and Medicaid Services from 2015 to 2017 and is an expert on healthcare. He wrote this op-ed yesterday: GOP should slow down and rethink health billGOP should slow down and rethink health bill:

      For millions of people, the Affordable Care Act has meant access to regular medical care for the first time. And for tens of millions more, the ACA protects us against being denied insurance because of a pre-existing medical condition or because we reached a lifetime cap.

      A few years ago, I came from the private sector to lead the implementation of the ACA after it got off to a rocky start. And I can say that while it’s not perfect, the ACA set us on a course of record progress in cost, quality and access to care and changed the lives of millions of people, many of whom I heard from every day.

      In comparison, the American Health Care Act (AHCA) pending in the House drives up the cost of individual insurance by an estimated 15% to 20% next year, according to the non-partisan Congressional Budget Office, and higher for older and rural Americans, to levels that can reach half of their income or more. About 24 million Americans would become uninsured over the next decade, including 7 million who get insurance through their employers. Medicaid funding would be cut by 25%, with hard caps put in place by the federal government. That would effectively ration care for millions of low- and moderate-income Americans, from needy children to seniors in long-term care facilities. […]

      I experienced these past few years what it’s like when one party is entirely responsible for carrying out the law, and I don’t recommend it to my Republican colleagues. As gratifying as it was to make progress, it was infinitely harder without support from the other side of the aisle.

      As we reach the seventh year of a law that has done so much — but without the bipartisan collaboration the nation has needed — the best question for your member of Congress is when is it time to slow down, abandon an ill-conceived bill, and reach across the aisle for a bipartisan solution?

    • He’s a must-follow on Twitter. I only discovered him about a week ago, and even in that short time, I’ve learned a lot.

      • Yes, he’s great! I have been following him since the inauguration when he moved from “Obama Administration Healthcare Policy Guy” to “Expert on Twitter”.

  2. The Republicans this morning are scurrying around trying to salvage their signature piece of crap legislation from defeat. In order to do that they are getting ready to repeal Title I (which includes pre-existing conditions, kids on policies until 26, and no lifetime caps) and to reduce the Essential Healthcare Benefits (EHB) list dramatically.

    House Republicans May Have Saved Trumpcare by Making It Even Crueler

    Earlier Wednesday, the Republican health care plan appeared all but doomed heading into Thursday night’s scheduled House vote. But a last-minute alteration has dramatically revived its prospects. Republican leaders are reportedly planning to add to the bill provisions to strip away essential health benefit requirements for insurance. This move would placate many, perhaps all, of the most arch-conservative opponents of the bill, making it far more likely to assemble a majority. It would also probably make the bill radioactive in the Senate by making the insurance system even more punitive and unaffordable to Americans with serious medical needs.

    The proposal is to eliminate ten essential benefits that, according to the Affordable Care Act, must be offered as part of any insurance plan. Those benefits are:

    • Outpatient care without a hospital admission, known as ambulatory patient services

    • Emergency services

    • Hospitalization

    • Pregnancy, maternity, and newborn care

    • Mental health and substance use disorder services, including counseling and psychotherapy

    • Prescription drugs

    • Rehabilitative and habilitative services and devices, which help people with injuries and disabilities to recover

    • Laboratory services

    • Preventive care, wellness services, and chronic disease management

    • Pediatric services, including oral and vision care for children

    Conservatives loathe these benefits, because they impair the pure free market function of the insurance system. In their ideal world, people could buy any kind of insurance they want. The most frequent complaint about essential health benefits is that it forces men to pay for maternity care. (Literally, this is the best example they can identify of a frivolous benefit Obamacare forces insurers to sell people.) Allowing people to customize their insurance allows them to buy cheaper plans covering only the kinds of medical treatments they want. Eliminating these regulations would make Trumpcare acceptable to the far right and probably, though not certainly, enable its passage through the House.

    The question now becomes “will making it crueler make it less palatable to more moderate Republicans”? I guess we’ll find out.

    • That NBC news piece also explained why it might not pass:


      – Inability to govern: After being conditioned to saying “no” during the Obama years, too many Republicans are unable to get to “yes,” no matter how imperfect the legislation is.
      – A divided party: The GOP remains fractured, which is illustrated by opposition to the House bill. One opponent is Ileana Ros-Lehtinen (R-FL), and Hillary Clinton carried her district by 20 points in 2016. Another GOP opponent is Rep. Louie Gohmert (R-TX), and Trump carried that district by 47 points. Others hail from districts that were decided by just a handful of points, like Leonard Lance of New Jersey and Brian Fitzpatrick of Pennsylvania.
      – Flawed policy: The Congressional Budget Office’s numbers on the legislation are jaw-dropping: 14 million fewer Americans would have insurance by 2018, and 24 million fewer would have it over 10 years. What’s more, older and more rural residents (read Trump voters) get hit hard, while wealthy investors get big tax breaks.
      – Broken promises: During the campaign and this legislative fight, Trump and his team promised: 1) “We’re going to have insurance for everybody”; 2) “I firmly believe that nobody will be worse off financially”; 3) “I’m not going to cut Medicare or Medicaid” — but the CBO shows that the legislation breaks those promises.
      – Didn’t learn Obamacare’s important lessons: In 2009-2010, Democrats got industry and major stakeholders to support their legislation; they went slow (the process took them a year); they reached out to the political opposition (Olympia Snowe voted for the Senate legislation out of committee); they united the party around the central tenets of the legislation; and most importantly, they held a supermajority in the Senate — or close to it. This current GOP legislative effort has followed none of these things.
      – A GOP Senate that’s not all that enthusiastic about House bill: “I would say to my friends in the House of Representatives with whom I serve, ‘Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote,” Sen. Tom Cotton (R-AR) has said.
      – Trump’s bad Monday: Confirmation of an FBI investigation into your campaign’s possible contacts with Russia and repudiation of your claim that Barack Obama wiretapped your phones didn’t help Trump win over wavering lawmakers.

  3. From my Senator, Tammy Baldwin, yesterday in an email:

    Tomorrow should be the seventh anniversary of the Affordable Care Act.

    Right now, we’re fighting to make sure this isn’t its last anniversary. Republicans in Congress are holding a vote to repeal the ACA and replace it with Trumpcare tomorrow.

    They want to replace a law that insured 22 million Americans and 200,000 Wisconsinites with one that will strip coverage away from 24 million Americans by 2026.

    Help me stop Trumpcare. The GOP needs to know how serious we are.

    I didn’t fight to pass the ACA seven years ago for political reasons. I fought to pass this legislation because more Wisconsinites could gain health insurance under the law.

    Health care is bigger than politics. We are dealing with people’s lives and livelihoods. The number one determinant of whether people can pay their medical bills or not is whether they have insurance.

    Under Trumpcare, many vulnerable Americans will be outpriced. Insurance companies will be able to charge seniors five times more than younger enrollees. Americans with pre-existing conditions will see their rates soar if they let their coverage lapse, and fewer low-income families will be covered under Medicaid.

    Even the provision allowing young adults under 26 to stay on their parents’ insurance is under attack. A Republican Congressman wants to amend Trumpcare to lower the age from 26 to 23.

    The ACA isn’t perfect, but it brings us a step closer to insuring all Americans. Trumpcare sends us stumbling backward.

    No family in Wisconsin or across the country should have to face financial ruin when they get sick. [Let’s] protect the ACA and stop Trumpcare.

    Thank you,


    • Full text of note, courtesy Fortune.

      When I took office, millions of Americans were locked out of our health care system. So, just as leaders in both parties had tried to do since the days of Teddy Roosevelt, we took up the cause of health reform. It was a long battle, carried out in Congressional hearings and in the public square for more than a year. But ultimately, after a century of talk, decades of trying, and a year of bipartisan debate, our generation was the one that succeeded. We finally declared that in America, health care is not a privilege for a few, but a right for everybody.

      The result was the Affordable Care Act, which I signed into law seven years ago today. Thanks to this law, more than twenty million Americans have gained the security and peace of mind of health insurance. Thanks to this law, more than ninety percent of Americans are insured – the highest rate in our history. Thanks to this law, the days when women could be charged more than men and Americans with pre-existing conditions could be denied coverage altogether are relics of the past. Seniors have bigger discounts on their prescription drugs. Young people can stay on their parents’ plans until they turn 26 years old. And Americans who already had insurance received an upgrade as well – from free preventive care, like mammograms and vaccines, to improvements in the quality of care in hospitals that has averted nearly 100,000 deaths so far.

      All of that is thanks to the Affordable Care Act. And all the while, since the law passed, the pace of health care inflation has slowed dramatically. Prices are still rising, just as they have every year for decades – but under this law, they’ve been rising at the slowest rate in fifty years. Families who get coverage through their employer are paying, on average, thousands of dollars less per year than if costs kept rising as fast as they were before the law. And reality continues to discredit the false claim that this law is in a “death spiral,” because while it’s true that some premiums have risen, the vast majority of Marketplace enrollees have experienced no average premium hike at all. And so long as the law is properly administered, this market will remain stable. Likewise, this law is no “job-killer,” because America’s businesses went on a record-breaking streak of job growth in the seven years since I signed it.

      So the reality is clear: America is stronger because of the Affordable Care Act. There will always be work to do to reduce costs, stabilize markets, improve quality, and help the millions of Americans who remain uninsured in states that have so far refused to expand Medicaid. I’ve always said we should build on this law, just as Americans of both parties worked to improve Social Security, Medicare, and Medicaid over the years. So if Republicans are serious about lowering costs while expanding coverage to those who need it, and if they’re prepared to work with Democrats and objective evaluators in finding solutions that accomplish those goals – that’s something we all should welcome. But we should start from the baseline that any changes will make our health care system better, not worse for hardworking Americans. That should always be our priority.

      The Affordable Care Act is law only because millions of Americans mobilized, and organized, and decided that this fight was about more than health care – it was about the character of our country. It was about whether the wealthiest nation on Earth would make sure that neither illness nor twist of fate would rob us of everything we’ve worked so hard to build. It was about whether we look out for one another, as neighbors, and fellow citizens, who care about each other’s success. This fight is still about all that today. And Americans who love their country still have the power to change it.

  4. Good morning, and thank you for the excellent post, Jan!

    Just read elsewhere that “Obama and the Congress should have bulled their way to single-payer back in 2010,” and almost choked. Have these people lost their memories? It was hard enough to get the ACA passed, let alone single-payer!

    The best we can hope for is that this will be such a fiasco that the House will be replaced in 2018 and we can get to single-payer in the next few years.

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