Trumpcare 2.0 Is a Death Bill. It’s Time to Fight for the System We Want.

Meaghan LaSala

Community members rallied in Albany New York on April 4 to declare that health care is a human right. (Alice Brody)

New fig­ures from the Con­gres­sion­al Bud­get Office show that, if passed into law, the so-called Trump­care” bill would spike the num­ber of peo­ple with­out health insur­ance by 23 mil­lion in 2026. While the GOP push­es dead­ly health­care roll­backs in Wash­ing­ton, com­mu­ni­ties from Penn­syl­va­nia to Maine are ramp­ing up their orga­niz­ing for uni­ver­sal health care at the state lev­el. New York and Cal­i­for­nia are cel­e­brat­ing major progress in their cam­paigns for state-based, sin­gle-pay­er sys­tems, set­ting the tone for grass­roots cam­paigns sweep­ing the country.

The Healthy Cal­i­for­nia Act and the New York Health Act would estab­lish improved Medicare-for-all-style sys­tems in each state, elim­i­nat­ing out-of-pock­et costs and guar­an­tee­ing com­pre­hen­sive care to all res­i­dents. The Cal­i­for­nia bill won approval from the Sen­ate Health Com­mit­tee in late April, and the Appro­pri­a­tions Com­mit­tee is expect­ed to vote on Thurs­day. Mean­while, the New York Health Act has sailed through the Assem­bly and now awaits action in the Senate.

Accord­ing to Ursu­la Rozum, upstate cam­paign coor­di­na­tor for the Cam­paign for New York Health, the list of endors­ing state sen­a­tors has jumped from 20 to 31 since the start of the leg­isla­tive ses­sion, bring­ing it just one vote shy of a major­i­ty. Rozum told In these Times that the bill’s suc­cess this ses­sion is at least part­ly a response to Trump’s regres­sive poli­cies, explain­ing that in this time of attacks on fed­er­al lev­el, I think it helps to say look, we have some­thing viable that could pro­tect New York­ers from the harms of the fed­er­al cuts to health care funding.”

These vic­to­ries con­sti­tute a pos­i­tive sign that state-based cam­paigns for uni­ver­sal health care ramp­ing up across the coun­try — and not just in states with pro­gres­sive leg­is­la­tures. In Maine, where Repub­li­cans main­tain con­trol of the Sen­ate and vot­ers have twice elect­ed the far-right, pro­to-Trump gov­er­nor Paul LeP­age, orga­niz­ers are demon­strat­ing non-par­ti­san, grass­roots polit­i­cal uni­ty on the issue of health care.

Such a sys­tem appears to have buy-in from ordi­nary Main­ers. I am a mem­ber of the South­ern Maine Work­ers’ Cen­ter (SMWC), a mem­ber-based grass­roots orga­ni­za­tion. We recent­ly released a report enti­tled Enough for All: A People’s Report on Health Care,” which shows that the vast major­i­ty of peo­ple sur­veyed between Feb­ru­ary 2013 and March 2016 believe health care is a human right, and that it’s the job of the gov­ern­ment to pro­tect that right. Com­mit­ted to build­ing a move­ment of work­ing class and poor peo­ple,” the report states, SMWC sought out peo­ple most direct­ly impact­ed by our system’s prof­it-dri­ven model.”

Over 70 per­cent of those sur­veyed report­ed that their right to health care is not cur­rent­ly pro­tect­ed. Maine is one of the 19 states that reject­ed Med­ic­aid expan­sion under the Afford­able Care Act (ACA). Maine is also the only state in the nation that has not seen a rise in the num­ber of res­i­dents with insur­ance since the imple­men­ta­tion of the ACA.

The SMWC’s report points out that the gap of cov­er­age in states that reject­ed Med­ic­aid expan­sion dis­pro­por­tion­ate­ly impacts peo­ple of col­or, deep­en­ing racial dis­par­i­ties across the health­care sys­tem. Accord­ing to a study by the Kaiser Fam­i­ly Foun­da­tion, black peo­ple are twice as like­ly as white peo­ple to fall into that cov­er­age gap. Nation­al­ly, more than half of all nonelder­ly unin­sured are peo­ple of col­or. For the SMWC, a uni­ver­sal health sys­tem based in human rights would be one where all health dis­par­i­ties are active­ly and sys­tem­at­i­cal­ly addressed.”

And while the cur­rent sys­tem cre­ates and exac­er­bates many health dis­par­i­ties, the SMWC points out that it is also not work­ing for the vast major­i­ty of peo­ple. For orga­ni­za­tions ral­ly­ing around the human right to health care, both the fail­ures of the cur­rent sys­tem, and the attacks on health care com­ing from the right, con­sti­tute oppor­tu­ni­ties to help peo­ple imag­ine a sys­tem that meets their needs. Rozum explains, if you want to resist Trump, we need to orga­nize around uni­ver­sal social pro­grams that take care of every­one, that unite peo­ple as opposed to being means tested.”

This strat­e­gy is reflect­ed in the SMWC’s approach to orga­niz­ing. In a recent inter­view, SMWC mem­ber Cait Vaugh­an explained the process of sur­vey­ing peo­ple for their report. What we were try­ing to do was engage peo­ple wher­ev­er they were at, whether they had lost their Med­ic­aid… were still on Med­ic­aid, whether they got insur­ance with the ACA… had no insur­ance at all, or even employ­er based insur­ance. We were try­ing to engage all these folks to fig­ure out, What are the real roots of the problem?’”

The SMWC is just one orga­ni­za­tion in a mul­ti-state col­lab­o­ra­tive of grass­roots groups also hail­ing from Ver­mont, Mary­land, and Penn­syl­va­nia that are using the lan­guage of human rights to build a base of grass­roots sup­port for uni­ver­sal health care. Nijmie Dzurinko orga­nizes with Put Peo­ple First Penn­syl­va­nia (PPF), anoth­er mem­ber orga­ni­za­tion of the Health Care is a Human Right (HCHR) Col­lab­o­ra­tive. Dzurinko told In These Times that it’s impor­tant to be work­ing at a scale we can influ­ence.” Dzurinko agrees with Rozum that state-based efforts are gain­ing trac­tion pre­cise­ly because we’re going back­ward in Wash­ing­ton. We have a strate­gic oppor­tu­ni­ty to push for a kind of health­care sanc­tu­ary at the state lev­el that insu­lates our peo­ple from the attacks and roll­backs of care at the fed­er­al level.”

The Ver­mont Work­ers’ Cen­ter (VWC), anoth­er mem­ber of the HCHR col­lab­o­ra­tive, won a his­toric vic­to­ry in 2011 with the pas­sage of Act 48, estab­lish­ing a path to pub­licly-fund­ed, uni­ver­sal health care in the state — the first of its kind in the coun­try. While still on the books, the act has yet to be ful­ly imple­ment­ed, in part because of for­mer gov­er­nor Peter Shum­lin put up road­blocks around equi­table financ­ing. The VWC con­tin­ues to orga­nize for full imple­men­ta­tion of the law, while push­ing back against the harm­ful impacts of the insur­ance-based sys­tem kept in place by the ACA. Blue Cross Blue Shield of Ver­mont has recent­ly request­ed12.7 per­cent pre­mi­um increase on exchange plans.

VWC mem­ber Ellen Schwartz explains, we’ll be tes­ti­fy­ing in July about how these rate increas­es affect us and our fam­i­lies and call for the full imple­men­ta­tion of Act 48 as the solu­tion. This is impor­tant because the rate hikes are a symp­tom of a sick health­care sys­tem, and it’s that sys­tem that we are chal­leng­ing and propos­ing to transform.”

The 2011 vic­to­ry of the Ver­mont Work­ers’ Cen­ter inspired sim­i­lar cam­paigns, like that of the SMWC, to view health­care orga­niz­ing as a winnable strat­e­gy and unite peo­ple around human rights. View­ing state-based orga­niz­ing as con­nect­ed to the fight over fed­er­al poli­cies, Dzurinko points to the fact that sin­gle pay­er sys­tem in Cana­da start­ed in the province of Saskatchewan before it was nation­al policy.”

With suc­cess­es like those in Cal­i­for­nia and New York thrown into the mix, sin­gle-pay­er sup­port­ers else­where in the coun­try may be spurred towards state-based cam­paigns. Approach­ing these cam­paigns with an eye towards build­ing broad bases of sup­port for human rights has the poten­tial to sow resis­tance against the larg­er trends of pri­va­ti­za­tion and dereg­u­la­tion, as well as racism and xeno­pho­bia, that mark the Trump administration.

Meaghan LaSala orga­nizes for health care jus­tice with the South­ern Maine Work­ers’ Cen­ter. Her writ­ing has appeared in Dis­patch, Alter­net, and YES! Magazine.
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