On June 28, 2012 a group of public health leaders nervously huddled together to focus on a steady stream of words being projected on to a screen. The collective of heath care providers, epidemiologists, administrators, educators, lawyers, and advocates who were previously gathered to discuss the American Public Health Association’s upcoming agenda and activities for the year, were now closely watching live coverage of the U.S. Supreme Court’s ruling on the constitutionality of the Affordable Care Act (ACA) signed in to law by President Obama in 2010. When the information came across the screen that the justices ruled 5 to 4 upholding the law, the palpable nervous energy in the room exploded into cheerful and tearful applause. This moment validated decades of tireless advocacy devoted to ensuring every person in the U.S. has access to high quality, affordable health care. The moment felt historic and affirmed that the laws and values of our country were in alignment on the right side of history. Sadly, this message has been replaced by an insidious barrage of misleading political rhetoric, actions, and inactions that prioritize the interests of our richest at the expense of our poorest.

Almost immediately into the new administration, the message from our elected officials and the Trump team to people living in poverty was clear, “we don’t care about you.” The Trump administration’s assault on the ACA began long before he was in office and once in power an early decision was made to gut funding for Health Insurance Marketplace outreach and enrollment efforts and cut the enrollment period in half. Despite these efforts, and with the assistance of relentless grassroots organizing, enrollment exceeded expectations for the abbreviated period it was open.

In September, Congress allowed the Children’s Health Insurance Program (CHIP) to expire leaving the families of 9 million children to spend the holiday season worrying about how soon they will lose health insurance. It is estimated that 2 million children will lose coverage in January alone. While it is likely that CHIP funding will eventually get reauthorized, it is uncertain when, for how long, or for how much. Unlike its ambivalence on the future of CHIP, the administration and congress has been clear about its plan to decimate the Medicaid program. In a speech delivered in November, Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS) announced that CMS will support work and other requirements in state Medicaid plans that that will serve the sole purpose of preventing individuals in need from accessing Medicaid. Reiterating Ms. Verma’s talking points, others from the Trump team and congressional leaders often use “state flexibility” as one of their expected achievements of their welfare reform efforts. This coded term refers to flexibility in order to make Medicaid less accessible to individuals who need it most through the removal of important rules that protect individuals in need. Those in favor for these reforms often fail to mention the massive funding cuts that will accompany the flexibility states will receive.

Finally, while attempts to outright repeal the Affordable Care Act have failed thus far, Congress was successful in passing the sweeping $1.5 trillion tax reform bill that will have long-lasting detrimental consequences to lower and middle class families for decades to come. Included in this expansive tax bill is a provision that repeals the individual mandate provision of the ACA resulting in an estimated four million uninsured by 2019 and 13 million without coverage by 2027. Sadly, these examples are few among many and do not include the countless other policy decisions and actions that will harm health such as penalizing sanctuary cities, eliminating net neutrality, failing to denounce white supremacy, slashing funds for critical services, and reinstating the failed war on drugs, among numerous others.

Today it is difficult to identify, let alone respond to, all of the attacks on our nation’s residents, especially those most at risk. Public health advocates long for the days following the passage of the ACA and subsequent U.S. Supreme Court decision where we felt hopeful, and that our nation was ripe for change and finally beginning to address the disparities that exist in health outcomes. Our hope today must come from a different place, from small and large victories defending what we know is worth fighting for, from the continued dedication of advocates and providers, and most importantly, from the individuals we serve. Until our leadership is on the right side of history again, we will find it elsewhere.

Shannon Mace

HELP: MLP Public Health Law Consultant