Republicans’ hopes of repealing the Affordable Care Act and replacing it with some draconian alternative are dead — at least for now. And we have bottom-up pressure to thank.
In the wake of last Thursday’s 49-51 Trumpcare vote, center-left pundits heaped praise on the three Republican senators who defected from their party to oppose the so-called “skinny repeal.” Arizona senator John McCain received the most adulation. He was singled out as a hero and a maverick for returning to Washington post–cancer diagnosis to maybe, possibly, not vote to take health care away from an estimated 16 million Americans.
Many on the Left shot back, pointing out that the real heroes of the health care fight have never held elected office.
Organizers on Capitol Hill and around the country spent several weeks fighting every health care proposal Republican threw out, marshaling a nationwide force that included scrappy direct action veterans, unions, well-resourced progressive groups, faith leaders, and socialists. The moral center of the battle was disability-rights campaigners, who helped set the decidedly militant tone for how to both save the ACA and Medicaid and demand more.
But there’s more to this win than a confirmation of the old adage that direct action gets the goods. It also helps map a path forward for beating the Right.
What pushed this at least temporary victory against the GOP over the edge was demonstrators’ ability to define the terms of the debate. On one side were people — some in wheelchairs, some battling life-threatening illnesses — who could quite literally die without Medicaid. On the other were a relative handful of wealthy Republican politicians intent on dismantling Obamacare and Medicaid simply because they’d promised to do so for seven years and because they wanted to cut rich people’s taxes.
“Even before they lost the repeal battle,” Adam Gaffney wrote yesterday, “Republicans had already lost the moral war. As a result, the Obamacare repeal effort — or more precisely, the response it provoked — may have inadvertently strengthened the conceptualization of health care as a basic social right . . . [I]f it is morally abhorrent to leave nearly 50 million uninsured (as Trumpcare would have done), why is it acceptable to leave 28 million uncovered (as the status quo law will do)?”
In this, organizers did what the Democratic Party leadership could not. While Minority Leader Chuck Schumer called the Senate version of Trumpcare, the BCRA, “mean-er,” demonstrators called it what it was: a death sentence.
Some of the most daring actions on this front came from ADAPT, a disability rights group founded in 1978 by a group of nineteen disabled Denverites who staged protests to make the city’s public transit system wheelchair accessible. Along with the AIDS advocacy group ACT UP, ADAPT helped pioneer dramatic and confrontational direct action that never shied away from spotlighting the life-and-death consequences of austerity.
One particularly famous ACT UP action saw members sprinkle the Capitol lawn with the ashes of people who’d died of AIDS. Among ADAPT’s most notable actions was the “Capital Crawl” in 1990, when around sixty wheelchair-bound demonstrators hoisted themselves up the Capitol steps to pressure House members to pass the Americans with Disabilities Act.
The most recent round of the health care battle also spawned new groups. One such formation, the Little Lobbyists, is an organization of children with complex medical issues who depend on Medicaid programs for their day-to-day care. As Emma Roller reported in Splinter, it was the brainchild of two “trach moms,” the mothers of children with severe respiratory issues.
In addition to the direct health impact Medicaid cuts would have on some of the country’s most vulnerable patients, ADAPT and similar groups warned that they could force many disabled people into nursing homes by slashing federal funds for home health care aids, essentially foreclosing on many people’s ability to live independently.
To counter all this, ADAPT used tactics that ranged from traditional lobbying and social media campaigns to town hall delegations, call-ins, and leafleting. Their direct actions put the conflict over the health care system’s future quite literally on elected officials’ doorsteps, daring Capitol police to arrest disabled constituents at their representatives’ offices. At a “die-in” outside of Mitch McConnell’s office in late June, police handcuffed forty-three people with disabilities. Videos of people being ripped from wheelchairs — in one case leaving a trail of blood behind — went viral almost instantly.
The fight carried on beyond the Beltway. During July’s congressional recess, fifteen people were arrested outside of Sen. Rob Portman’s office in Columbus, Ohio. Ten ADAPT members mounted a two-day sit-in in late June at Colorado senator Cory Gardner’s office, insisting that they’d “rather go to jail than die without Medicaid.” In all, ADAPT held around forty protests over the last several weeks, helping create a raucous scene in Senate and House office buildings.
These actions also inspired larger and more resource-rich groups such as the Working Families Party (WFP) to host calls to action like early July’s Sit-In To Save Lives, co-convened by WFP, Our Revolution, Democratic Socialists of America, and several other progressive outfits. Northern Nevada’s WFP held weekly protests outside the home offices of Sen. Dean Heller, who later pulled his support for the BCRA. At least twenty different protests were launched around the country as part of the wave of action in early June, in locations from Alaska to South Florida.
The outpouring of opposition to the GOP’s plan helped generate a positive feedback loop: bad press for McConnell and his ilk forced them to push through legislation using the least democratic means imaginable, generating even more enmity. The apex of this trend came last Thursday, when Republicans released a bill hastily drafted by a handful of GOP leaders after sundown and tried to ram through a vote the same night. The result was still more public outrage.
So what lessons can be drawn from organizers’ success in stymying the GOP’s push to repeal Medicaid? And how can they be applied to other fights ahead?
For one, direct action is key.
It’s worth remembering that Medicaid probably wouldn’t exist were it not for the decade of militant, disruptive activism that preceded its implementation. Medicaid and Medicare were each passed into law through the Social Security Amendments of 1965, just a week before the Voting Rights Act.
Campaigners like Martin Luther King had pushed to desegregate hospitals, and he and many other organizers saw the right to health care as a crucial front in the struggle for civil rights. Organizations like the NAACP and the National Medical Association, a black professional organization that split from the then-segregated American Medical Association, were vocal advocates for health care reform, using every tactic from lawsuits to civil disobedience. As Vann Newkirk III reported in the Atlantic last month, NMA head W. Montague Cobb was the only leader of any medical association to speak out in favor of the two programs.
And beyond health care–related demands, the broader social and political climate that the Civil Rights Movement had created gave social movements increased bargaining power in Congress and the Oval Office. The War on Poverty as a whole was largely a response to the Black Freedom Movement.
The cascade of protests that have defined the most recent fight over health care didn’t just make it more politically risky for politicians to support the various Republican repeal and replace efforts. It also, as Gaffney notes, opened space for single-payer, support for which reached new heights over the course of the fight to save the ACA.
A Gallup poll in January found that 28 percent of Americans supported a single-payer program. By June that figure had risen to 33 percent. Among Democrats and Democratic-leaning voters the increase was even more dramatic, jumping from 43 percent support in January to 52 percent by June. Nearly two-thirds of self-described liberal Democrats now back Medicare for All, along with a majority of House Democrats.
The upshot of these numbers extends beyond just health care. Whatever the current ideological make-up of “The Resistance,” there are now, at minimum, tens of thousands of people around the country hungry to enter the political arena and stop Trump. And they’re eagerly looking for direction as to what to do.
A relatively small array of organizations is prepared to bring them in and introduce them to the basics of grassroots organizing — let alone the innards of left politics. Movement veterans like ADAPT can set the tone for what activism in the Trump era might look like moving forward, encouraging Women’s March attendees and Indivisible members, for instance, to support if not join in more escalated protests. In the process, these groups can set a high bar for the kinds of ambitious policies they want to put on the agenda, all the while racking up wins and political capital by successfully stonewalling the GOP’s plans.
It’s possible, in other words, to reject liberalism while embracing the many liberals eager to fight the powers that be and introduce them to an entirely different way of doing and understanding politics. By almost any measure, a movement at present that’s comprised solely of self-identified leftists is dead on arrival.
As Frances Fox Piven and Richard Cloward wrote in Poor People’s Movements forty years ago, “protest movements do not arise during ordinary periods; they arise when large-scale changes undermine political stability,” adding that:
At times of rapid economic and social change, political leaders are far less free either to ignore disturbances or to employ punitive measures. At such times, the relationship of political leaders to their constituents is likely to become uncertain. This unsettled state of political affairs makes the regime far more sensitive to disturbances, for it is not only more likely that previously uninvolved groups will be activated — the scope of the conflict will be widened — but that the scope of conflict will be widened at a time when political alignments have already become unpredictable.
For a Republican Party in crisis, a widespread revolt — one involving people who have never been involved in activism of any sort — can do more damage than it would have even a year ago. Achieving the kind of scale that can effect real disruption, however — the kind of disruption that gets things done — requires bringing at least tens of thousand more people into the fold. By bringing people from across the anti-Trump resistance under the same banner, the health care fight has offered a positive example for how this can look on other fronts, and build a commitment to transformative, life-saving policies like Medicare for All.
That’s not to say that substantive tactical and ideological disagreements should be papered over. But it’s up to socialists to win the battle of ideas against liberal pundits and politicians as the anti-Trump resistance starts to congeal. That the growing number of people opposed to Trump’s agenda are not coming to the fight as fully realized anticapitalists should be seen as a challenge rather than a reason to dismiss the #Resistance out of hand, or lump potential recruits in with its most embarrassing public figures.
Of course, resisting the White House shouldn’t be the only goal of organizing in the Trump era — there’s a world to win. But polarizing the public and new recruits around life-and-death issues like health care, pointing out just how depraved Republicans’ plans are, can whet even liberal appetites for more far-reaching solutions.
Crucially, they can also give people the chance to get their hands dirty in militant, grassroots organizing. And that’s exactly what we’ll need to defeat the GOP and pave a path toward governance.