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November 17, 2017

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Here’s how to stand up and resist Trumpcare

Since Donald Trump’s election, a loose coalition of citizens, doctors, nurses, activists and others has rallied together to prevent their fellow Americans from losing health insurance. They won a big victory last month when Congress set aside its efforts to pass a destructive bill. But now the coalition has a new fight.

Trumpcare has begun, not through legislation but through executive action.

The administration has taken several steps to deprive people of health insurance. In doing so, it has both a short-term goal (have the federal government do less to help vulnerable citizens) and a long-term goal (sabotage Obamacare, so that Congress can more easily repeal the law).

Trump will probably accomplish at least part of the short-term goal and take insurance away from some people. But it is possible to minimize the damage, through an effective political response. Whether you’re a Democrat, Republican or independent — whether you have been part of the citizen activism or not — I encourage you to get involved.

I know that activism can make people uncomfortable. To be honest, urging activism makes me a bit uncomfortable. (My original plan for today’s column involved the psychological lessons of the baseball playoffs.) But some principles — like access to decent medical care — are worth the discomfort.

How can people get involved? Start by understanding exactly what Trump is doing.

His main strategy is trying to prevent healthy people from entering the normal insurance market. The administration has all but stopped advertising the Obamacare insurance exchanges, which serve people who don’t have coverage. Absent this outreach, people who desperately need insurance — the sick — will dominate sign-ups, and prices will soar. Imagine if the life insurance market were dominated by people who’d already turned 80.

Trump’s recent executive order went further in this direction. When it takes full effect, it will most likely allow a variety of cheap insurance plans that don’t cover many treatments. These plans will siphon healthy families from the normal markets, raising prices on the sick.

It will work nicely for healthy families, until it doesn’t. If they get sick and want insurance that pays for their treatments, they will be out of luck.

The executive order was one of two moves Trump made the week before last. He is also trying to cause chaos by canceling federal reimbursement payments to insurers. Without those payments, insurers may exit the market, leaving consumers without options.

Throughout, Trump has been pretty blunt about his intentions. He wants to make Obamacare “implode,” and, in the process, make repeal less politically toxic. His plan is dark, though not implausible. The Senate came within a single vote of repeal this summer.

But everyone who believes in decent medical care has ways to fight back.

First, it’s important to talk about what Trump is doing, with friends and family, on social media and in person. Sixty percent of Americans believe that Trump and Republican leaders are responsible for Obamacare going forward, according to the Kaiser Family Foundation. That number deserves to keep rising.

If it does, Congress will feel pressure to undo some of Trump’s mischief, much as some members felt intense pressure to vote against repeal. Remember that many members of Congress, unlike Trump, are on the ballot next year. And Congress could easily restart the reimbursement payments he has stopped.

Second, activists can play a role in encouraging people to sign up for insurance — since Trump won’t. Several former Obama administration officials have started a group called “Get America Covered,” and it has published an online guide for volunteers. Now is a good time to get involved, because open enrollment starts next month. “We need your help spreading the word,” tweeted Lori Lodes, who runs the group.

Finally, there are the lawyers. Trump’s actions are legally vulnerable in several ways. Yuval Levin, who worked in the George W. Bush administration, has written that it considered taking some actions similar to Trump’s, but concluded they were illegal. State attorneys general have begun some legal challenges, and more may follow.

Just as Trump has both short-term and long-term goals, so should his opponents. For now, the priority is minimizing coverage losses, through outreach, lawsuits and lobbying. Doing so will also help the larger priority: preventing repeal, which would cause far more people to lose insurance than Trump can on his own.

“This stuff is really bad,” health care expert Aviva Aron-Dine said, referring to Trump’s recent announcements, “but it’s not nearly as bad as repeal. People should be able to hold both of those ideas in their head at the same time. Nobody should despair.”

So far, advocates for health care — both the professionals and the amateurs — have done a remarkably good job of choosing passion over despair. Don’t stop now.

David Leonhardt is a columnist for The New York Times.

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