President-elect Donald Trump and the Republican Congress are determined to repeal the Affordable Care Act. It’s the first thing on their January agenda, and they are arguing over how quickly it can be done. But what if their own conservative voters organized to stop them in their tracks? It’s not as far-fetched as it sounds.
If the Republican Congress repeals Obamacare, I will lose my health insurance along with 4.6 million Californians. Like me, 1.4 million people in the state buy their health insurance through Covered California, the private insurance exchange enabled by the ACA. But even more benefit from the ACA’s expansion of Medicaid — known in California as Medi-Cal — the program that pays for 100 percent of your health care costs if you are senior, poor or disabled.
When the ACA passed, it urged states to expand their Medicaid coverage to more working-class people whose incomes had been too high to qualify previously. And California eagerly exercised the option, since the ACA also covers most of the cost. As a result, California’s Medi-Cal rolls have grown 75 percent to 13.8 million, more than a third of the state’s population.
That’s worth repeating: More than one-third of all Californians have federally subsidized health care.
When you add up the federal subsidies that go to Californians under the ACA, it’s about $20 billion. This is why California, more than any other state, has a lot to lose if Obamacare is repealed.
If the ACA goes away, California would either have to yank coverage from 4.6 million people, or cough up $20 billion a year to fill the gap. And $20 billion is a wrecking ball of a number — almost twice as much as the state pays for its prisons, and about 16 percent of the state’s annual general fund budget. Making up this difference will be extremely painful.
This Democrat–controlled legislature will absolutely raise taxes, and it will be forced to make deep cuts in other areas.
But here’s an interesting twist: Republican counties stand to lose the most if Obamacare is repealed. According to the California Budget and Policy Center, six of the 10 California counties with the highest Medi-Cal enrollment are in the Central Valley. These six counties are represented by Republican members of Congress: Tom McClintock (R-4), Jeff Denham (R-10), David Valadao (R-21), Devin Nunes (R-22) and Kevin McCarthy (R-23). Every single one of these guys is eager to repeal the ACA, as their voting records show.
It’s confounding why a county like Tulare, with 55 percent of its residents on Medi-Cal and the third-lowest per capita income in the state, consistently votes for Republican legislators — the very people who are champing at the bit to take away their federal benefits — to represent them. It’s common knowledge that the white working-class tends to vote against its own economic interest. This disconnect is how a lot of journalists and political experts explain Trump’s election, and why Democrats are tearing their collective hair out over the new political reality.
But here’s how we help these voters connect the dots: Supporters of Obamacare must hit the streets. As President Barack Obama said in his farewell address on Tuesday, “If something needs fixing, lace up your shoes and do some organizing.”
I believe that if these Californians understood what was at stake, they’d stop the repeal in its tracks. Every single Medi-Cal recipient in the Central Valley needs to know that their health care hangs in the balance. Coverage for folks under age 26 by their parents’ insurance, protection of pre-existing conditions against discrimination, Medi-Cal availability for more of the working class … these are life-impacting provisions of the ACA that will hit people hard if they disappear.
And we tell these anti-tax Republican voters that their taxes will go way up if the federal subsidies go away. Because it’s true.
I’m picturing billboards in the 23rd Congressional District saying, “Congressman Kevin McCarthy wants to take away your Medi-Cal.” The California Nurses Association should call every working family in these counties to get them activated. Direct mail, social media, rallies at stadiums, knocking on doors: These are classic, grassroots organizing tools that unions and medical organizations know how to use that can actually turn an electorate around.
We may not be able to convince these folks to vote differently in the next election, but if we can get them to understand the stakes, we can make it politically impossible for this Congress to hurt its own constituents.
If you’re motivated to help here in San Francisco, Sen. Bernie Sanders and House Minority Leader Nancy Pelosi are holding a day of action on Sunday called “Our First Stand: Save Health Care.” It starts at 1 p.m. on the steps of City Hall, 1 Dr. Carlton B. Goodlett Place.
Alix Rosenthal is a municipal attorney, nasty woman and progressive activist who mentors and trains women to run for political office. She can be found on Twitter at @alixro and her blog is at www.votealix.com.