Trump has launched his opening salvo against the Affordable Care Act.

What’s going on?

Within hours of his inauguration, Trump signed an executive order designed as the first executive step to dismantling the Affordable Care Act, also known as Obamacare.

In brief, the executive order commands federal agencies to interpret the law as loosely as possible in enforcement terms, and gives states more flexibility in how they implement the law’s requirements.

Why is it important?

Republican attacks on the ACA have persisted since before it was even passed into law. Congress has already taken its first steps toward a full repeal, without offering up a replacement.

The ACA has expanded healthcare access to tens of millions of Americans, primarily by making health insurance easier to obtain, expanding Medicaid in some states (many have refused to accept the expansion), requiring coverage for pre-existing conditions, and allowing young people to stay on their parents’ insurance until age 26.

A repeal would destroy that progress and represents a severe disruption to the lives and health of tens of millions of people. It will be costly to roll back, too: insurance companies, drug manufacturers, healthcare providers, and other companies and workers in the healthcare industry have invested millions of dollars and tremendous amounts of time in implementing the law and adhering to its provisions. Those efforts cannot be unwound with the stroke of a pen–another round of disruptive adjustments will be required, for a legal change that offers nothing but a return to the status quo that existed in 2009.

This is to say nothing of the millions of people with chronic conditions whose very lives are threatened by a repeal. There is perhaps no more urgent issue in the early days of the Trump administration than the protection and preservation of the ACA.

What can I do?

None of us can undo an executive order, obviously. But this was just one step toward a full repeal, which must be carried out by Congress and signed by the President. This means there are many actions we, as individuals, can take, both to help protect the law and to safeguard our own lives and health against the worst outcome.

First, consider how the law benefits you. Has it given you access to insurance that you didn’t have before? Have you benefited from federal subsidies to pay your premiums? Do you have a pre-existing condition that is now covered? Are you a minor under 26 who has been able to keep insurance because of your parents’ coverage? Are you a parent with a child under 26 that you’ve been able to keep under your plan? Were you able to get on Medicaid because of the ACA? Do you use Medicare Part D?

If your answer to any of those questions was “yes,” then you have materially benefited from the ACA. Odds are, people in your life have benefited, too. If they are in favor of repeal, remind them of how they benefit from the current law, and that Republicans are promising to repeal it without giving any indication of what they would replace it with–potentially eliminating those benefits permanently, with no hope of return. Some people are not even aware that the ACA and “Obamacare” are the same thing. If you encounter such a person, inform them of this fact! Educate yourself, and do what you can to educate others.

Contact your Congressional Representative and Senators. You can find out who represents you here–all you need is your ZIP code. Phone calls are more effective than other methods, so call if you can. Tell your Representative and Senators to defend Obamacare, and describe how you and other people in your life need it–point to the tens of millions of Americans who have benefited significantly from it. Stress that the right thing to do is identify and address the law’s shortcomings, not dismantle it completely. Do this even if you’re calling Republicans! If they sense there is a groundswell of opposition to repeal, they may reconsider. They want to win re-election, after all.

Find out whether your state government has adopted the ACA, such as by setting up their own healthcare exchange and implementing the Medicaid expansion. With that information in hand, contact your governor and state legislature Representative and Senators, and either implore them to defend the ACA through state-level measures or move toward adoption if they haven’t already. Again, stress the benefits of the law and how much damage will be caused if it is repealed, and encourage your state leadership to take up the provisions of the ACA on their own if the federal government is going to abandon them.

Finally, if you are a current beneficiary of the ACA, evaluate your own options. Plan for the worst, if you can. I cannot say that there are options for everyone, but the good news (to the extent there is any) is that no matter how quickly a repeal goes through, it is unlikely to take effect within the next year, and the current assumption is that it will not take effect until after the 2018 midterms, so that the effects of a repeal won’t be felt until after the next election. This would obviously be a cynical move by Republicans to protect their jobs against a deeply destructive and unpopular repeal, but it also means you have time to evaluate your options and make other preparations.

I doubt this will be my last post on this issue, and each time it emerges, I will offer new details as best I can. This fight is only just beginning.

Photo by majunznk