Supporters of the Affordable Care Act (ACA) are in a tough position. Once Donald Trump takes office next month, the threat of a Senate filibuster will be the only thing keeping Republicans from being able to do whatever they want – or at least whatever they can agree to amongst themselves, from repealing Obamacare to privatizing Medicare and block granting Medicaid. Republicans can actually make significant health policy changes without having to worry about the filibuster, such as by using regulation to alter climate change policy at the EPA or the Congressional reconciliation process to repeal the major coverage provisions such as the individual mandate, the exchanges, and the Medicaid expansion. I suspect Congress will punt on some of the toughest ACA questions, passing major decisions on to the states. Once again, states would then become a primary battleground in the fight over health reform.
Supporters of the ACA should look to an uncomfortable place for ideas on how to respond: the Tea Party . The Tea Party was amazingly effective at influencing policy outcomes in states around the country, in many cases beating an unprecedented coalition of the historically most powerful interest groups in health such as insurers, hospitals, doctors, small businesses, and consumer advocates. I have interviewed more than 200 policymakers about these fights, including many Tea Party activists. I have learned at least seven lessons from this research that supporters of the ACA should consider as they try to save the ACA:
1) Get involved – Tea Party activists (as opposed to politicians who co-opted the movement) were almost always regular citizens with virtually no experience in government. They were not even political junkies who paid disproportionately close attention to policymaking. They were grandmas and grandpas who were deeply concerned with the direction they saw their country heading. They were not polished, but if anything this enhanced the sincerity of their message. They did not wait for invitations to get involved or formally join an organization. They self-mobilized. If you really disagree with Paul Ryan or worry about what Donald Trump will do, then you need to get involved .
2) Make it personal – Where should you begin? By personally connecting with your elected officials . Politicians care deeply about re-election and so generally make themselves accessible to constituents. Tea Partiers did not just write letters and disagree on social media, they called and made staff members listen to them. They showed up at district coffee hours and vented to their representatives. They dropped by their legislators’ office. They went to town hall meetings and spoke up. This article does a great job summarizing tips from a former Congressional staffer (@editoremilye) on the best ways to get your representative’s attention.
I did not always agree with Tea Party activists I interviewed, but I was almost always impressed by their commitment . I regularly came away feeling that our political discourse and policy outcomes would be very different if more Americans across the political spectrum showed the same level of interest and dedication. One of the most important ways to fight for the rights of vulnerable populations is to make sure politicians see the people behind the arguments. Immigrants, LGBT youth, and recently insured Americans need to put their stories out there and personally introduce themselves to their leaders. The daily reality of work and family obligations mean it will be harder to get involved than it is for retirees, but these voices need to be heard.
Regular people wanting to affect policy outcomes should make a point of understanding how Congress and their state legislatures work. Figure out how to follow the process and show up at key moments.
3) Learn the process – The Tea Party first gained prominence through its large rallies around tax day in 2009, but activists had the most influence by inserting themselves in the minutiae of the policymaking process. For example, one leader in Michigan wrote on her blog that “Attendance at a Committee Meeting is more effective than large rallies” (emphasis in the original). In my forthcoming book I chart the spike in the number of Tea Partiers that attended committee hearings about an exchange in the subsequent months and the effect this had on the outcome. Many of them testified against an exchange, but even the mere presence of groups as small as 10 people has the ability to dramatically change the dynamic. Legislators are chronically worried that a spike in attention is just the tip of the iceberg signaling that many more will mobilize if they vote the wrong way.
Regular people wanting to affect policy outcomes should make a point of understanding how Congress and their state legislatures work. Figure out how to follow the process and show up at key moments.
4) Need for leadership – There is no such a thing as THE Tea Party. It is actually a decentralized collection of local movements. This is an advantage in many ways but creates a power vacuum. National and state-level organizations played an important role as the de facto leaders in many states. Sometimes these were conservative think tanks and sometimes they were dark money groups funded by the Koch brothers. They did not have power in a heirarchical sense, but they were instrumental in educating regular citizens on the policy-making process and explaining policy debates in simple terms. They alerted people through social media and blogs about key hearings or legislative votes. If a grassroots movement defending the ACA and blocking Trump is to succeed, these types of organizations will need to step up.
There is no reason that supporters of the ACA and those who disagree with Donald Trump can’t take back ownership of words like freedom and liberty.
5) Simplicity of ideology – The Tea Party movement is driven by fairly simple ideology. I was often jealous of an interviewee’s ability to boil any complex argument to two words: freedom and liberty. Did the policy in question enhance or jeopardize freedom? They were not interested in talking about the risks of adverse selection; an insurance mandate is bad because it restricts liberty. Just about anything that increases the role of government should be resisted because it infringes on freedoms.
We have to appreciate that better evidence is not enough to win policy arguments; we have to tap into core American values . There is no reason that supporters of the ACA and those who disagree with Donald Trump can’t take back ownership of words like freedom and liberty. Policies that would limit immigrant rights or restrict access to health care should be framed in these terms. People are not free if life, liberty, and the pursuit of happiness are not options.
6) Redistricting reform – Priority number one should be changing how Congressional districts are drawn . As I wrote right before the election, the shape of our maps dramatically affect everything about our politics. Balancing our districts won’t guarantee that Democrats will win a majority or even more seats – but that is not the point. The goal is to move our arguments to the center where the incentive is to compromise and solve problems rather than stay on the extremes where the incentive is to fight and resist compromise.
7) Warning – There are a number of risks to encouraging grassroots activism of this sort on the left. For one, I am a firm believer that population health goals transcend partisan politics. Public health needs a stronger stomach for politics and should focus more on building more bridges than getting in the mud. The Tea Party stoked an unhealthy “us vs. them” mentality that culminated with the ugly 2016 election cycle. What I am imagining for would hopefully have the opposite effect. We should reject political discourse that is personal and mean. I am intrigued by Van Jones’ call for a #LoveArmy to reach out with “respect to the Trump voters who don’t subscribe to everything he has ever said.” As Jones puts it, “The problem is not the abundance of people with bad intentions; it’s the superabundance of people with good intentions who don’t know what to do yet.”
If you are one of these people, I suggest you get involved, personally meet your elected officials, learn the policy process, and advocate for redistricting reform.
Image: adamzyto, Tea Party Rally – NYC, used under CC BY/cropped from original
