Relevant Policy Background:

The ACA is fully paid for by a variety of mechanisms split between tax increases, fees imposed on providers and cost-savings generated by reforms to the healthcare delivery system.

The single largest tax that funds the ACA is an expansion of the hospital insurance tax, used to fund Medicare which is part of the FICA that everyone pays on the first dollar of income. Before the ACA, the tax was a flat 1.45 percent on all earned income.

Obamacare changed that in two ways, both of which made the tax much more progressive.

First, the ACA added an additional bracket of 2.35 percent for all incomes over $200,000 ($250,000 for married couples).

Second, the law also extended the tax to unearned investment and interest income. So, for all incomes over $200,000 ($250,000 for married couples), non-wage income was subject to a 3.5 percent surcharge. This is the first time in U.S. history unearned income has been subjected to a payroll tax. [1]

The Congressional budget Office estimated in 2010 that the two provisions combined would bring in about $210 billion over the first decade of the ACA, enough to pay for about 20 percent of the law's costs by itself (When combined with other provisions, it pays for the law's costs completely and then some).

The largest costs of the ACA are subsidies for people purchasing insurance on the exchanges, and funding to expand Medicaid to everyone earning under 138 percent of the poverty line.

A reconciliation bill would likely repeal these taxes and the subsidies. This means that people included in the Medicaid expansion would lose their insurance, while the people buying insurance on the exchanges would lose their subsidies that reduce their premiums and out of pocket costs.

In return people in the top 1 percent -- earning more than $430,000 a year – will see an average tax cut of $25,000 a year. People in the top 0.1 percent – earning more than $1.9 million a year – will see an average tax cut of $165,000. [2]

OK, that's lovely policy-wonk talk, but how do I turn that into an easy talking point?

  • The GOP is taking away health insurance from 32 million poor and middle class people to give the top 1 percent a massive tax cut that they don't need.

Sample Script: (note, this is a base, adjust it a little bit if you have a story, or to make the prose more comfortable for you, but keep the central point.)
"Hi, my name is X I'm a constituent of Y, may please speak with the staffer who handles health policy?"

  • Give your name and address if asked (you don't have to, but doing this confirms you're in their district and gives you credibility)
  • Ask who you are speaking with, record their name and title.
  • "I'm upset that Congress is trying to repeal the Affordable Care Act. I don't think it's right to take away health insurance from 32 million people to give billions in tax cuts to rich people. (THIS IS YOUR SPECIFIC POINT) [If you have a story here – like you were on an exchange plan, or know someone who could get care because they got an ACA plan, work it into your script here before calling)
  • "Can I count on Congressman Y to stand behind the ACA and protect the health care of the millions of people who have insurance thanks to Obamacare?" (THIS IS YOUR ASK)
  • Write down answer
  • Thank them if they say yes
  • Stand your ground politely but firmly if they hand you a talking point, say "no," or try to hide behind the idea that they can't express and opinion for the Congressperson.
    • For example, some variation of the following should get your point across: "It's morally wrong to take away people's health care to give more money to people who are already wealthy. [MENTION PERSONAL STORY HERE IF YOU HAVE ONE] I think Congressman Y's position is unacceptable."
    • Thank the staffer for their time
    • Report back to the group and post on social media about your encounter.
    • Praise the Congressperson if they commit to protecting the ACA
    • If you got a particularly wrongheaded or rude response, write a letter to the editor documenting it.


[1] For an excellent summary of this and all other things ACA, read John McDonough's book, Inside National Health Reform. The discussion on the payroll tax is in Chapter 13

[2] See Matt Yglesias' take on at a Tax Policy Center study that summarizes this all here: http://www.vox.com/policyand-politics/2017/1/17/14...