The 2016 election turned on racism, xenophobia and anger at the status quo, including the Affordable Care Act (ACA). The law covered about 20 million, and modestly improved access to care. But it didn’t address the health care problems facing most working families, feeding the perception that the Democratic Party had neglected them. Trump seized on the ACA as a symbol of the establishment’s false promises, and has placed repeal at the top of his to do list.
There are many indicators of what Trump has in mind to replace the ACA, but they’re pointing in different directions. We suspect that the likeliest replacement is a meaner (and rebranded) facsimile of the ACA that retains its main structural element — using tax dollars to subsidize private insurance — while imposing new burdens on the poor and sick.
A few suggestions for work in the months ahead:
1. Colleagues are, more than ever, receptive to the single-payer message. …
2. With Medicaid under attack, in many states we’ll need to join in its defense. …
3. We need to help focus the anger at elites onto the real health care elites: insurance and drug firms, and corporate health care providers.
4. In the past PNHP has focused narrowly on single-payer reform, avoiding participation in most broad-based coalitions. … Effective action will require coalitions that span many issues.
5. It’s time to ramp up organizing for H.R. 676.
Drs. Woolhandler and Himmelstein are professors of health policy and management at the City University of New York School of Public Health at Hunter College and lecturers in medicine at Harvard Medical School. They co-founded Physicians for a National Health Program.
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