Congratulations!

We have won the first battle of the Trump Era in
the struggle to save and build on the Affordable Care Act (ACA)!
Congress couldn’t muster a majority to steal health care from millions of voters. We mobilized
and stopped the Trump agenda in its tracks. A huge thank-you to every person who has
marched, attended a town hall, visited your congressperson, made phone calls and sent
emails. People power is what stopped the ACA repeal, and even ultra-conservative members of
Congress had to shift their positions when faced with the people who mobilized to challenge
them in their home districts.
But that was only the first act. We cannot stop now. The stated plan of Speaker Ryan and
Donald Trump is to do everything that can to sabotage the ACA. First, we have to stop Trump
and Health and Human Services Secretary Price from engineering the collapse of the ACA,
which they can do administratively. Trump made clear that ACA sabotage is his new strategy:
"The best thing politically is to let Obamacare explode."
Here are just a handful of the things the Trump Administration could do to undermine
the ACA so that it collapses—on us, the voters:
 Create barriers to Medicaid. Work requirements, frequent recertification, and
premiums/co-pays would leave millions of people uninsured, keep them from getting
preventative care, and force them to go to emergency rooms for everything else. This will
ultimately severely burden hospitals that are already struggling with the loss of federal
dollars for bad debt and charity care.
 Undermine the essential benefit package. Our recent efforts preserved this set of
core health services, but Secretary Price could counter by narrowly defining and limiting
these requirements. Here we are talking about vaccinations, reproductive care, maternity
care, post-natal care, mammograms, well-health check-ups, and much more.
 Refuse to underwrite insurance losses on the exchanges, thereby forcing plans to
either jack up their premiums or leave the marketplace. Trump has already stopped enforcing
the insurance mandate. He is pushing rules that will make it harder to qualify for benefits. He
could stop paying out individual and family subsidies, dramatically narrow the enrollment
period or take other actions to discourage enrollment. For example, one of the Administration’s
first actions was to defund advertisements promoting ACA enrollment. Additionally, while
exchanges in most parts of the country will remain completely stable if left alone, there are at
least five states where there is only one plan available, including Pennsylvania and other largely
rural states.. If these markets aren't shorn up, rural people, for whom health care is least
accessible, will face steep premium increases or the loss of any coverage.

WHAT’S NEXT IN THE FIGHT TO SAVE & EXPAND AFFORDABLE CARE:
This moment of challenge is also a moment of opportunity. Trump has signaled he would
ultimately like to work with Democrats on bipartisan health care reform legislation. We should
hold him to his word. He promised universal coverage. The quickest move in that direction
would be to persuade states that did not expand Medicaid to do so now. In the long term, the
only way to ensure universal coverage is to implement single-payer insurance. The simplest
way to do that is to expand Medicare to everyone, as proposed by Senator Bernie Sanders.

This is why we need to make the April Recess hot as hell for members of Congress. We
need them to commit to fortifying the ACA and opposing any effort by the
Administration to destroy it. We need them to champion Medicaid expansion, to
champion stronger drug pricing measures, and to champion Medicare for all.
We will help you organize and attend the town halls or other public meetings of your elected
officials—or help organize accountability actions if your senator or congress member is hiding
from constituents. Now is the time to make the ACA work even better for all Americans.
Thank you for being a part of the resistance. We are winning, and we are the majority!

TOWN HALL OR MEETING AGENDA:
 BEGIN WITH ACCOUNTABILITY: If your Representative came out opposed to the
Ryan ACA Repeal bill, say thank you! If the member indicated a yes vote or sat on
the fence, give him or her holy hell. The bill was a travesty, sacrificing health care for
millions of vulnerable people to pay for tax cuts for the wealthy, and undoing important
protections for most Americans. Only 17% of the U.S. adult population supported the bill.
The members of Congress who failed to vociferously oppose the bill were comfortable with
robbing benefits from many tens of thousands of their constituents. In New York State,
between 58,000 to 130,000 people per congressional district would have lost health
coverage, averaging almost 85,000 people per district. What was your Congressperson’s
margin of victory?
 Demand that your Representative commit to each of the following and put
each commitment in writing:
 Fight any legislative efforts to repeal ACA.
 Fight any effort to undermine Medicaid through work requirements, co-
pays/premiums, or frequent recertification.
 Fight any effort to undermine the health care exchanges and instead find ways
to strengthen struggling exchanges (e.g., restoring funds for “risk corridors”).
 Become a vocal champion of full and unfettered Medicaid expansion if you
live in a state that has not expanded Medicaid, or one that expanded but
attached onerous provisions (i.e., Indiana).
 Support bipartisan legislation to control drug prices. Drug prices are the single
largest cause of increases in health care costs annually—especially insurance rate hikes.
President Trump and many Democrats have pledged to support changes in law to allow
Medicare to negotiate drug prices. The U.S. government also needs to revoke
pharmaceutical corporation patents when they price drugs higher than the next 10
richest countries. All other wealthy nations have the ability to break a monopoly when
a company is taking excessive profits.
 Support Medicare expansion to cover everyone. By eliminating administrative and
marketing costs and negotiating prices from a position of power, Medicare for all would
reduce health care costs across the country by an estimated 20% or more.
 Extra credit: Support insurance coverage for all immigrants who need it,
whether they have papers or not! It is a matter of public health! Every child,
woman, and man needs access to health care. This is not only good public health
policy, but it will also save states and municipalities money since localities eat the
emergency and hospital costs for uncovered immigrants.