Will the Health Care Act Survive?

By Richard Kirsch

I woke up New Year’s morning with a nervous stomach. It was finally 2012, the year that I’d been talking about casually since people started asking me, “will the Affordable Care Act survive?” As I wrote in the epilogue to my new book, Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States, health reform has to jump two big hurdles in 2012 to survive. The first is the Supreme Court ruling on its constitutionality, with three days of oral arguments in March now just a few weeks away. The second, of course, is the election for President.

On the campaign trail in Iowa, Rick Santorum baldly revealed why the right is so intent on killing the promise of good health care for all: Santorum said it would make people “dependent” on the government. As I write in my book: “The right understands that if the Affordable Care Act is implemented, it will create a bond between the American people and government, just as Social Security and Medicare have done. The last thing that the corporate and ideological right want is for a new health care pillar to be added to the foundations of government social insurance.”

The battle over the Affordable Care Act needs to be understood in its historic context. While the legislation that passed was certainly compromised from an ideal law, it will for the first time – when its key measures are implemented in 2014 –establish a government responsibility to make decent health care affordable to almost everyone. Following a century of failure, during which the United States emerged as the only developed nation to guarantee health care, the passage of the ACA needs to be understood as a remarkable accomplishment.

That history weighed over the battle that began in 2008, when I helped found Health Care for America Now (HCAN), a coalition that as health care historian Paul Starr told me, was the first time that there was a major grassroots, field campaign to pass reform. Fighting for Our Health is the story of that campaign, starting from its early roots in 2003, when Yale professor Jacob Hacker and I separately developed a new policy approach, the public option. We each envisioned the public option as a way to bridge the gap between those who championed single-payer government health insurance and reforms based on expanding private health coverage. As I write: “It is impossible to overstate how important the idea of the public option was to creating the powerful unified coalition that became HCAN.”

In 2008, many of the largest multi-issue progressive organizations came together under a common set of principles to form HCAN. During the next two years, HCAN ran a $48 million coalition, grassroots and media campaign, with field partners organizing pressure on members of Congress and actions aimed at the health insurance industry in 44 states. Our strategy included turning Congressional supporters into champions, like Washington State’s Patty Murray, who met 11-year old Marcelas Owens at a rally of 5,000 in Seattle in May, 2009. That meeting with Owens, whose mother had died because she didn’t have health insurance, led Marcelas to the U.S. Senate, to become a target of Glenn Beck and finally to stand next to President Obama, wearing matching powder-blue ties, when he signed the ACA.

The story of how Marcelas Owens ended up at the White House is one of many that I tell in Fighting for Our Health, each aimed at capturing the drama and illuminating the strategy that drove us to victory. I describe:

How we organized small businesses in the districts of conservative Democrats, taking them on Main Street tours.

The biggest story missed by the press, how we beat the tea party attacks by turning out more people than they did at

Democratic town halls and rallies from mid-August through Labor Day in 2009.

How we thanked House Democrats who voted for the bill and spanked Democrats who voted against it in 2009, a key strategy in getting a majority of House members to vote for the final legislation in 2010.

The campaign we ran on TV and in the streets to get the message out, “If the insurance companies win, you lose.”

The tension with the White House, which tried to stop HCAN from defending a strong bill.

At the end of the day though, we were all on the same side, celebrating passage of legislation that – if it survives 2012 – will make affordable health care a right in the United States. To see that promise fulfilled, we’ll need the President, Congressional Democrats and activists to make it clear why the Affordable Care Act will be a huge step forward in creating a country that works for the 99%. We’ll need to remind the public that once the ACA is implemented in 2014, it will mean that losing your job, retiring early, or starting a small business won’t result in losing access to affordable health coverage. It won’t mean you could go medically bankrupt.

The ACA became law because of the passion of activists and Democratic elected officials for creating a more just America. We defeated the Republican part, the tea party, the U.S. Chamber of Commerce and the health insurance industry. In 2012, we need to do it again.

Activist Richard Kirsch led the progressive campaign Health Care for America Now, which helped to get the nation's Affordable Care Act passed. His new book, Fighting for Our Health, tells a fascinating tale about how the progressive coalition worked with groups all across the nation to pass the bill.