Part of a series of background guides, talking points, and phone scripts for a coordinated defense of the Affordable Care Act

by Patrick O'Mahen

Relevant Policy Background: The Individual Mandate

The individual mandate of the Affordable Care Act is an important linchpin that keeps premium prices under control.

How? Think of the ACA as a three-legged stool. First, it offers anyone not covered by an employer plan or other public insurance the ability to buy a plan on an insurance exchange (guaranteed issue) at the same price as anyone else (community rating). This is great, but healthy people will tend not to buy insurance, which leaves the pool sicker, which causes prices to increase. Then more healthy people leave the pool, causing the pools to keep getting sicker, which causes prices to go up more. This eventually causes a death spiral.[1]

The individual mandate plays a critical role in keeping healthy people in insurance pools by charging them a fee if they do not enroll in insurance.[2] For the ACA, that fee is $695 and or 2.5 percent of a person's income, whichever is greater, for 2017.

Remember, the third leg of the ACA then offers subsidies to purchase insurance for people who require financial assistance, and anyone who can't afford insurance (which is defined as a percentage of their income)

This is an entirely reasonable and useful piece of public policy... but Republicans want to get rid of it anyway.

The Senate Republicans have a problem. They want to cut taxes for big corporations and rich people (particularly passive investors and rich heirs that look a lot like the Trump family, but I digress). But under Senate rules, they can only increase the deficit by $1.5 trillion over the next 10 years. They've tried to pay their tax cuts by zeroing out most useful tax deductions that poor and middle-class people rely on, but they've run out of those.

The Congressional Budget office has said that repealing the individual mandate will cause 13 million people to lose health insurance over the next decade. They won't be paying the mandate penalty into the treasury, but they won't be getting tax subsidies to buy insurance either. Overall, taking away those subsidies nets $346 billion over the next 10 years, which can be used to repeal the estate tax, which only applies to the value of estates over $10 million and is paid by less than 1,000 estates in the US yearly.

Here's the bottom line: Eliminating the individual mandate will raise health insurance premiums for middle-class people and cause 13 million people to lose coverage so that rich people can get more tax cuts.

Phoning a Congressperson's office[3]

What to do:

  • 1.coordinate the topic, ask and timing with a group
  • 2.Call your Senator
  • 3.Call your other Senator
  • 4.Call your U.S. representative
  • 5.Go ahead and call both their Washington and their local offices
  • 6.Be polite but persistent
  • 7.Be specific to one topic
  • 8.have one ask (e.g. Vote no on the current attempt to repeal the Affordable Care Act)
  • 9.take notes on what you are told
  • 10.report the results back to the group and social media

To find contact info for your reps and Senators look here: www.callmycongress.com.

What not to do:

  • 1.Don't e-mail alone
  • 2.Don't merely post on social media
  • 3.Don't call reps who are not yours – they don't care because you can't vote in their district
  • 4.Don't discuss multiple topics – it dilutes your message.

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 or Tax 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 calling because I oppose the Republican Tax Bill. In particular, I really hate cutting the ACA's Individual Mandate and Medicare. Throwing people off of health insurance and raising their premiums to cut taxes for really rich people and big business is abhorrent."

[If you have a story here – this is a good place to put it]

"Can I count on Senator Y to oppose cuts to Med in any bill that comes out of the Senate?"(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 (see below bold):
  • If they pull the "Individual Mandate is unfair and forces people buy insurance they don't need" crap tell them that the mandate keeps insurance affordable for working and middle-class families and eliminating it will throw 13 million people off of their insurance according to the CBO.
  • (More below)

IF "the Senator is still considering their options" or "No" say

"I don't think throwing 13 million people off of insurance and cutting Medicare so rich heirs and big businesses can get tax cuts they don't need is good policy."[MENTION PERSONAL STORY HERE IF YOU HAVE ONE] I think Congressman Y's position is cowardly and I will be telling all my friends and family that he thinks his big donors are more important than common folks."

  • 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, throw them a rhetorical brickbat if they waffle or say no. If you got a particularly wrongheaded response, write a letter to the editor documenting it.
  • Keep organizing!

Only call your Senator – any phone call is good. If you live in their states, especially push Moore-Capito (WV), Portman (OH), Murkowski (AK) Collins (ME), Gardner (CO), Collins (ME) and McCain (AZ), Flake (AZ), Corker (TN) and Alexander (TN)

Notes

[1] Incidentally, the high prices caused by having a risk pool full of sick people is one reason why underfunded high-risk pools (a favorite pet rock of many Republican policy makers) tend to work poorly.

[2] Hey, don't take my word for it, check out what these smart people have to say in the New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMp1013067

[3] The Indivisible Guide has several techniques for working a phone call. The script I suggest below is the simplest. They suggest trying to get in touch with a policy staffer, which has the advantage of taking up the time of senior staff members and hitting closer to the representative himself.However, even flooding the zone of junior staffers and interns is useful.See https://www.indivisibleguide.com/ for more.