Inside the fight to save Obamacare: how one longtime advocate plans to fight repeal

Last summer, Obamacare’s future seemingly secure, longtime health advocate Ron Pollack announced he would retire in March 2017.

“I had expected to move on to something else, and I was looking forward to that,” Pollack says.

The election changed all that. Pollack has spent decades fighting for the expansion of health coverage in the United States. He is the executive director of Families USA, one of the key advocacy groups that helped pass the Affordable Care Act. He then helped found another group, Enroll America, which has led efforts to get people signed up for coverage under the new law.

With Obamacare’s future in peril under an incoming President Trump and a Republican Congress, Pollack has shelved his plans for retirement and now wants to fight to preserve the law’s coverage gains — or make the Republicans pay a significant political price for eroding them. He has begun building a new coalition of groups that support Obamacare.

Pollack and I spoke Monday afternoon about his strategy for defending Obamacare, whether he thinks congressional Democrats can work with Republicans on a replacement plan, and why he thinks repealing the law will be more difficult than conservatives expect.

What follows is a transcript of our discussion, lightly edited for length and clarity.

Sarah Kliff

Tell me a little bit about what role you see Affordable Care Act supporters playing in the coming weeks, months, and years as we open up this new debate over the future of the law.

Ron Pollack

On Wednesday [after the election], we quickly figured we needed to start the process and get people focused. Literally at noon, give or take a few minutes, we sent out a notice to advocates around the country that we were going to do an audio conference at 3 pm to talk about what we need to do to protect people. Three hours later we had 1,079 people on the conference call. We had people from 49 states. We only missed Wyoming.

I say that as an anecdote because there are people who are really energized, even in their despair, about making sure the enormous benefits that have been achieved through the ACA are not eroded.

We have been working every day since the election to create a new coalition, called the Coalition to Keep America Covered. We believe this will be a multi-year campaign. That may sound a little odd, but here’s why: If the Republicans succeed and pass repeal and even a replace bill in early 2017, the implementation will be delayed quite significantly. People currently have contracts in place with their insurers. And the Republicans aren’t going to want to cut people off shortly before the 2018 election.

We think they’ll aim for around January 2019 — and that means we’ll know for quite a long time what the impact is on people. I think if the campaign is done really well, and we really get the word out, there will be the makings of an extraordinary backlash.

It’s one thing for people not to get something. But when they get it, and find it valuable, and then you try to take it away — I think we have got a shot at certainly causing political problems for those who pass cut back legislation.

But at least as important as ensuring that the backlash occurs is trying to ameliorate the damage. We want to make sure the 20-odd million who got covered with Obamacare and much larger number of people on Medicaid who could really be hurt if it’s converted to block grant — we want to make sure there truly is a significant backlash. When you don’t have the levers of power, you’ve really got to make sure that there is an outcry that has potential for significant political consequences.

Sarah Kliff

Do you think there is a path to preventing a repeal bill from becoming law? Or is that an inevitability at this point?

Ron Pollack

I don’t think it’s easy for the GOP to do what they claim they were going to do about repeal of legislation. Take the example of Kentucky’s new governor, Matt Bevin. He abhors the ACA and campaigned against it, and is trying to get waivers to undermine some key parts of Medicaid. But at the end of the day, he didn’t get rid of Medicaid expansion.

That example is illustrative of this phenomenon of taking something away from people that they think is valuable, and how hard that is. So I don’t think we’re without opportunities, at a minimum, to ameliorate the damage.

Sarah Kliff

There’s a big difference between ameliorating the damage of repeal and stopping repeal altogether. Do you think the latter is possible?

Ron Pollack

Nobody is prepared to say repeal will happen. We are certainly going to fight it. At the same time, we’re going to look at what can be done if repeal occurs to get a replacement plan that is protective of the majority who are getting health care.

They may offer something that is a far cry from protecting preexisting conditions, for example. But the fact that there are already statements being made that we’re not going to repeal preexisting conditions is a good thing; there are things we are going to retain. It’s indicative of a wake-up call that has happened.

It’s one thing, rhetorically, to say you’re going to repeal the entire statute. But once you start drilling down on how you do it, it becomes a whole lot more difficult. When people start complaining about the changes, Republicans are going to own America’s health care system.

Sarah Kliff

This is something I was thinking about earlier today — that it almost feels like good news for the Affordable Care Act that straight-up repeal doesn’t seem really on the table right now. That all the debate has immediately gone to what the replacement looks like.

Ron Pollack

I think there is a political imperative to say we’ve repealed the legislation. It’s almost like the joke we’ve been making about expanding Medicaid — that all states will eventually expand, but in Texas it won’t be Obamacare. It will be Alamocare. I think right now the GOP is feeling, politically, like they need to say they repealed Obamacare. But that doesn’t mean they have to decimate coverage for everybody.

Sarah Kliff

What do you see the role of congressional Democrats being in the upcoming debate? Should they be working with Republicans to improve a replacement plan? Or should they be an opposition party, putting all these changes on Republicans’ shoulders?

Ron Pollack

The week that Obama was inaugurated, there were meetings among Republican legislators to make sure that his presidency would not be successful. Democrats have got to say, we’re on the right side of expanding coverage, we have to stand up and be bold, and not join forces with Republicans, so that anything that happens is attributed to Republicans. The Democrats’ first job is to stiffen their spines and make sure they are committed to resisting the kinds of changes that Republicans have suggested.

Sarah Kliff

So is there any space then for Democrats to work to improve replacement legislation, maybe a bill that doesn’t retain all of the ACA’s coverage gain but gets close to it?

Ron Pollack

At this moment, there has to be anticipation of resistance. If they’re willing to offer something that is protective, then you can take a look. But right now, nothing should occur other than clear opposition and making that opposition as visible and as human as possible. We’ve got to present the faces of real people that are going to be harmed.

Sarah Kliff

So when you look at Better Way or the Patient CARE Act, two replacement plans from Congress, is there a space for Democrats to make that better?

Ron Pollack

It is totally premature to talk about that.

Sarah Kliff

Can you tell me a little bit more about your new coalition to protect the ACA? What will the focus and message be that you’re trying to get out?

Ron Pollack

This is in development, of course, and we’ve been reaching out to lots of organizations, both nationally and grassroots. The thrust of the coalition is to really portray the enormous damage and to get as many voices heard about why this is bad. We want to plant the seeds for an incredible backlash. And obviously there are so many techniques for doing that. We hope this will be an all-fronts campaign. For every person or organization that fought for health reform or expanding coverage, you can’t abandon this fight.

Sarah Kliff

I know you were planning to retire as executive director of Families USA. Is that still the plan?

Ron Pollack

One way or another, this is a 24/7 matter for me for years to come. I had expected to move on to something else, and I was looking forward to that. But that was changed Wednesday morning. I cannot abandon this. I may be working at a different organization, but I’m going to be working full time to defend coverage gains.