The health care war is far from over: Neera Tanden

After eight years of fear-mongering and spreading outright lies about the Affordable Care Act, Republicans finally got the chance to step to the plate and give it their best swing.

And they whiffed. Hard.

House Speaker Paul Ryan even lost support from the most electorally secure Republicans in his caucus. Meanwhile, President Trump proved that his world-famous negotiating skills are better suited for reality television than reality.

But we should chalk up the GOP’s defeat to more than mere incompetence. For starters, it was a disastrous piece of legislation that would have devastated working families, sent premiums skyrocketing, and left 52 million Americans uninsured by 2026 (compared with 28 million under current law). And all in order to fund another giant tax cut for the wealthy.

Indeed, when faced with a choice between what we have today through the Affordable Care Act and Ryan’s proposal, the public chose the Affordable Care Act; today the ACA is more popular than it’s ever been. As countless people around the country — including many Trump supporters — shared their stories about how the ACA has helped or even saved their lives, public perception of the law began to shift and it is now topping majority support in some polls.

That’s why Democrats must do everything they can to keep protecting the ACA from Republican attacks. Because while Republicans lost a major battle Friday, the health care war is far from over.

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Nothing prevents Republicans from reviving this fight at any point over the next four years, especially under a president as impulsive and erratic as Trump. What’s more, Health and Human Services Secretary Tom Price has a range of tools at his disposal to unilaterally weaken the ACA. Through regulations he can weaken the insurance exchanges that are covering so many Americans. He can undermine the insurance mandate and thereby create an actual death spiral. Price could undermine the essential health benefits that we now know people want.

It is simply unacceptable that the Trump administration would knowingly hurt the health care of Americans, their own constituents, out of spite. Democrats need to shine a light on such attacks and proactively confront the lies that Republicans continue to spread about the ACA’s popularity and stability. Not only has the ACA garnered more public support, but the nonpartisan Congressional Budget Office confirmed that the law is not in a death a spiral — disproving a central talking point pushed by Trump and Republican leaders.

As Democrats have said for seven years, they are willing to fix the law. Mend it not end it.

There are even some ideas with GOP backing that Democrats could work on. The House bill had a stability fund to reimburse high-cost enrollees — let’s do that. In most cases the tax credits in the House bill were a raw deal. But in some cases for some middle-income people, they were higher than under the ACA — let’s top up the ACA tax credits to those levels without taking away from others. Trump has talked repeatedly about fixing prescription drug prices. I agree with that and let’s act on that. And this will pay for the other things we want to do above. Finally, we do need more insurance competition and that’s why there should be a public option for insurance.

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However, all this means building on the ACA — not tearing it down.

If Trump wants to serve the public, he’ll put away his hatchet and sit down with Democrats to fix the ACA. So far, he’s not off to a good start. After failing to ram through a bill that had a mere 17% of support among Americans, Trump promised to let the ACA wither. But with his party in control of both chambers of Congress, Trump owns the health care reality now. Since he has the power to make improvements to the law, he will be held accountable for any bumps ahead. And if he comes from a place of fixing the ACA — as Americans want — rather than destroying it, then Democrats will work with him.

But so long as Trump and Republicans vow to take away health care from millions of Americans, Democrats should not give an inch. Nor should they only play defense. The people who won this battle are those who have benefited from the law and whose voices were heard in the process. Democrats must continue to tell those stories and solidify the ACA’s support — and not just when the law is under siege.

Friday was a good day to be a Democrat. But now is not the time to spike the football. After canceling last week’s vote, Ryan predicted that “we’re going to be living with Obamacare for the foreseeable future.” For the sake of millions of Americans who rely on the ACA, Democrats must prove him right.

Neera Tanden, president of the Center for American Progress, was asenior adviser for health reform at the Department of Health and Human Services in the Obama administration. Follow her on Twitter @neeratanden

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