Please help save the Affordable Care Act and Medicaid. Your calls, faxes, and emails can save lives.

This is not a history post, Gentle Readers; please will bear with me anyway. I am grateful for every one of you, whether you stop by once or check every day. Knowing that you are there; that there are people who value what I write here enough to give the time to read it has helped me in ways too numerous to count. I would not have done the research without the readers, so you have benefited me tremendously. I understand the past and present so much more deeply now than I did a few years ago. The skills I’ve learned here have served me in other communities, most notably Reddit’s AskHistorians, where I have met new friends dear to me. The ability to come here five days a week and do something that I know others value, and contribute in a small way to the internet’s largest history enthusiast community, are deeply precious to me. All this together has done much to improve my mental health. It all started here, because some friends encouraged me to do this thing. I’m not in touch with all of you anymore but if you’re reading this; you know who you are. Please understand how much of a difference you’ve made in my life.

As I said, this isn’t a history post. Nor is it history adjacent or historically-informed commentary on recent events, as I’ve done in the past. I feel I’m presuming on you, as I’ve done once before, to even make it. I don’t do so light; I’ve put it off most of the day and I feel guilty writing it now, but I’d feel worse if I didn’t. The long and short of things is that I’ve been losing sleep over the latest plan to destroy the Affordable Care Act, Obamacare, and eradicate Medicaid in the bargain. It’s called Graham-Cassidy and it’s the worst bill yet. It has a better than even chance of becoming law, perhaps even this week but most likely next. I’m not a health care expert, so I can’t walk you through the ins and outs of it. But those people exist and they’ve been sounding the alarm on and off for a month, then much more seriously starting late last week. It’s gone from a longshot in the Senate to one vote shy of passage. Here’s the briefest summary I could find:

Slavitt, who ran Medicare and Medicaid for President Obama, knows more about these issues than just about anybody. He also produced a bullet points list of what Graham-Cassidy would do:

A summary of Graham-Cassidy

This is a bill to end Obamacare, but it’s also one to destroy Medicaid. It takes us back not just to before 2010, but all the way back to before 1965. The sponsors will argue that it doesn’t, but by replacing a federal entitlement for anyone in need with block grants they have ensured it. Block grants are just piles of cash which states can use for anything. They shrink as the years go on and were built originally to strangle programs that politicians didn’t like but couldn’t get enough support to destroy outright. The American people often forgive tremendous malfeasance, but we do have our limits. The block grants end entirely in 2026, at which point Medicaid either ceases completely or the cost is borne entirely by the states. As states usually have balanced budget constitutional amendments and it’s very difficult to raise revenue, that means at minimum and long before the ten years run out they will have to drastically cut eligibility, benefits, or both to the people who need them most desperately. That includes people on life-sustaining care and people who only have a livable quality of life because they can get help. If this law passes, people will die because of it. Before Obamacare, tens of thousands died every year because they couldn’t afford health care. After it, they will again. It’s not a perfect law, just the best we could do in 2010. People are alive today who would have died but for it. The same goes for Medicaid.

Two weeks ago we thought they did not have the votes for this. We believed that after the one vote defeat in the Summer that the GOP had given up and moved on. Most of us, myself included, forgot the lesson of the House vote: Back in March, we thought for sure that after giving it one go the Republicans had given up. They regrouped, produced a far more radical bill, and hammered it through without hearings and with a margin of two votes. The life-destroying ACA repeal / Medicaid eradication is never more at risk of passage then when we think it dead. Now momentum is building, in part because Graham-Cassidy shamelessly plunders the states that expanded Medicaid to pay temporarily for the budget hole they’ll dump on the states that didn’t. Guess which states have more Republican legislators in them. A few GOP states will take a massive haircut too, but those are deemed acceptable losses. I don’t want to wallpaper this post with images, but here are two more to give you the current details:

If you’d rather read it in text form, then here’s an explainer. The bill will probably 32 million people without insurance, which combined with the present uninsured would leave us worse off than we were before Obamacare. The ban on refusing coverage or charging more for pre-existing conditions would be among the legislative casualties. Lifetime limits would be back. Insurers could sell you a junk plan and hike your rates the instant you got sick. Cassidy-Graham took everything Americans hated about health insurance in 2009 and opted to go for worse still.

My state, Michigan, will lose $3,041 billion in federal health care money in 2026, and far more after. We are not the poorest state, but we can’t afford that. Few states could. When it comes time to choose who will suffer, the most vulnerable are always first on the list. The most vulnerable in the United States include plenty of white people -my mother and I both presently get our insurance through the ACA- but white Americans have done our best to ensure that the most vulnerable are disproportionately not people who look like us. I know that’s a terrible thing to say, but it’s true. Right now Arizona stands to lose a lot too, but since John McCain (R-AZ) cast the deciding vote last time you can bet they’re working on a way to make sure Arizona gets into the plus column. The last time, his governor told him that the state couldn’t afford it. This time we probably don’t have that luxury. Furthermore, McCain and Lindsey Graham (R-SC) are close friends. He’s the Graham in the bill’s name.

I don’t want to embed an entire thread of tweets -I have imposed on you enough- but if you want the full state of play then please look at this thread:

I know this is the fifth time we’ve had to beg our members of Congress to let us keep having health care so we can keep living, keep having lives worth living instead mired in pain and worry. But it might be the last time. The special rules that the Senate presently uses to pass things by simple majority (50 Republicans plus the Vice President, in this case) expire September 30 and the GOP have made it clear they want the next turn with those for tax cuts. Wikler currently expects a vote late next week. It looks bad for all of us who care about our fellow citizens. According to polls, that’s an overwhelming majority of Americans. Even among Republican voters, none of the bills to date have been popular. The GOP knows that and has tried to sneak every one of them through without a thorough review and due consideration.

We let that happen once before, but we stopped it twice over the Summer. This is still a democracy and the people still have power, as dark as things look. The greatest power we have now is our voices. The votes were lined up before and one fell out. One can again, but we need massive and unrelenting public pressure. We need to show up and be loud, reminding politicians that they work for us. Not everyone can make it to DC for a protest or visit a field office, but we all have phones and we all have the internet. It’s time to light the wires on fire for ourselves and, most importantly, for each other. Write letters to the editor calling our your congressmen and Senators by name and calling on them to fight. If they’re already a confirmed no, then thank them and make sure they stay that way. If they’re a yes, tell them to reconsider. Do it even if your Senator’s name is on the bill. You are literally their boss.

You should get in touch with your governors too, especially if they’re Republicans and you have a GOP senator. You can do it on your own, or through the Capitol switchboard (202) 224-3121), or with the help of Resistbot. (The switchboard will not have your governor’s number, but Resistbot does.) Resistbot will give the right phone numbers via text or Facebook messenger. It will also allow you to send faxes, all completely free and easy to use. There’s no limit here; you can fax, or call every day. If something changes during the day, you can do it again. They’re not going to throw your message away because you rang twice. I have horrific phone anxiety so I use the faxes. The worst that’s ever happened to me was receiving a letter from my congressman. If you’re not sure what to say, then there are scripts you can use and there’s no shame in doing it.

All that said, please only contact your congressmen, senators, and governors. They’re the people who work for you. It’s dishonest to pretend you’re local when you’re not and if staffers get the impression that most of the people who contact them are from out of district then they’ll ignore genuine messages along with the bad. Our democracy can’t afford that on any issue, now or in the future.

I know it’s hard to do this; it’s harder still to have to keep doing it. It’s hard enough for me to keep at it. I can’t imagine what it’s like for someone with sick loved ones. We can still turn this around. It might come down to obstructionist dirty tricks, but everything about the progress of this legislation on the GOP side has been one dirty trick after another. Call on your senators to withhold consent and filibuster by amendment to run down the clock. Call on your governors to lean on your Republican senators, especially if you live in Arizona. If you don’t feel confident writing your own faxes, please steal mine. This is what I’ll send to my Senators (both Democrats, you’ll have to adjust for a Republican) every day for the next two weeks:

Medicaid and the ACA are in the GOP’s firing line again with Graham-Cassidy. It’s the worst version yet. The law would destroy tens of thousands of lives. I’m sorry, but it’s so. You have got to take this deadly seriously. Assume they have the votes and be ready to obstruct to save those lives. I can’t tell you how difficult this is for me personally, and I don’t presently rely on either program for essential services. Imagine how people who will soon die without them feel. For them and all of us, you have got to pull out all the stops.

Be loud on your social media. Toss out senatorial courtesy and withhold consent on everything until after September 30, when the reconciliation runs out. Be ready with amendments to filibuster during vote-a-rama. They have eight working days left. You can gum this up and force the GOP to move on. You are not powerless. You have got to stand up for the people of Michigan and every other state. We need you desperately. Please do everything it takes.

This is something we can do for ourselves and, more importantly, for each other. Or it’s something we can not do and just let the bodies fall where they may; we have a history of that. But it’s not the only history we have and history is not destiny. We each make it in our ways small and large, through all the things we choose to accept or choose to fight. This is a time to fight. We can’t all be abolitionists or civil rights workers, but we can stand against the wrongs in our own time. There are people suffering now that we can help with the bipartisan bill being worked on Senate committee. There will be far more suffering and far fewer helped if Graham-Cassidy passes.

I don’t want to ask you for anything but your time, but if you can do this then please do what you can. Calls, faxes, telling friends, everything can help. Spread these resources around; I don’t need credit and you don’t need to share my prose with them unless you want to. Let the people who represent you know that you can’t stand idly by and watch them consign your fellow human beings to untold misery, insecurity, and death. If this is presumptuous, if I have broken the social contract between us then I’m sorry. These are things I had to say.

Thank you for listening. There’ll be history tomorrow.

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