One year after the Tea Party insurgency disrupted Democratic Congressional town hall meetings, it’s worth asking how healthcare reform survived. By the beginning of 2010, Scott Brown had taken Ted Kennedy’s Senate seat, reform proponents had lost the national narrative and voters in swing states around the country had soured on reform.
Still, health reform became law, an achievement that for all its flaws, finally establishes a government obligation to make health coverage affordable. How, despite all the odds, did it happen?
The victory was no accident. The progressive campaign to win healthcare reform was several years in the making and was based on a well-developed and resourced plan, from which we can take key lessons for other progressive campaigns. Here is what we did to win.
Early in-depth public opinion research: A coalition of groups joined in a two-year project to identify public attitudes towards healthcare reform. We found that: we needed to reassure people that they would not lose the coverage they liked but would instead gain more choices, affordability and security; it's futile to compare ourselves to other countries, in a nation that firmly believes that we’re number one; and we need to animate anger and hope as the antidote to the opposition’s main weapon, fear. We also found evidence—not surprisingly—that the popular target for anger was the insurance industry.
A unifying policy proposal: It’s difficult to understate the importance of the public option in creating unity among most of the organized left. The public option bridged the gap between the deep desire for single-payer among healthcare activists and the reality that neither the American public or political system could tolerate having everyone enroll in a government health insurance plan. Without the public option, we would never have been able to put together the coalition that formed a strong, well-resourced campaign to win reform.
A broad, progressive coalition: We built a coalition, Health Care for America Now (HCAN), from among the biggest multi-issue, progressive organizations, particularly those able to mobilize people outside the Beltway. The twenty groups that eventually made up HCAN’s leadership included major unions, community-organizing networks, netroots groups and organizations representing women and communities of color and think-tanks. The coalition agreed to ten specific principles for reform and the leadership organizations each made a major commitment to the campaign of money, staff and membership mobilization. The combination of unity around policy and mission and significant investment in the actual campaign meant that the coalition would do what most people thought impossible: stick together to the end.
A detailed campaign plan: The HCAN Organizing Committee wrote an 865-page campaign plan incorporating: grassroots and netroots organizing; communications through traditional, paid and new media; coalition building including creating a new organization of small businesses; fundraising; and a new round of public opinion research focused on generating anger at the health insurance industry.
Resources to win: If there’s a single hero in this story, it’s Gara LaMarche, the President of Atlantic Philanthropies, which made a $10 million grant to HCAN early in 2008, assuring that we would have enough resources to launch the campaign in the crucial months before the 2008 election. The $51 million amount we raised between 2008 and 2010 from Atlantic and other funders, including our Steering Committee, was sufficient to run a campaign that placed us at the center of reform efforts.
Launching early: HCAN launched in July 2008, months before the November election, with thousands of people participating in fifty-three events in thirty-eight states. We spent the next four months asking members and candidates in both houses of Congress to sign a statement supporting the HCAN principles for reform. By Election Day, 140 sitting members of Congress had signed the statement, including the president- and vice president–elect.
Organizing Congressional champions: Most recent progressive campaigns have concentrated their efforts in swing states and Congressional districts. HCAN instead focused on developing champions in Congress and bolstering the large majority of Democrats who were inclined to support reform. This strategy proved key to helping Congress to persist through the most difficult times. Of course we ran big campaigns aimed at swing Democrats too, but we did not base our fortunes on their fickle positions.
Building on established progressive capacity: Rather than hiring outside organizers, HCAN built local coalitions in forty-four states, through three established networks: USAction, the Campaign for Community Change and ACORN. We funded seventy-five organizers who coordinated the work of paid and volunteer organizers from the local affiliates of our steering committee members and from other organizations that made up our 1,100-member coalition. HCAN’s online staff, working with MoveOn and others, added a huge Internet presence.
Local coalitions held thousands of public meetings and press events with members of Congress and made hundreds of visits to their offices. Regular call-in days generated hundreds of thousands of calls and faxes. When the Tea Party attacks came in early August, members of Congress called on the HCAN coalitions for help. While our response didn’t make as dramatic press coverage as the angry Tea Partiers, the truth is that the HCAN coalition, working with Organizing for America, turned out as many, and sometimes two to three times as many, people as the Tea Partiers, to Democratic Town Halls around the country during the three weeks before Labor Day. Grassroots organizing continued throughout the campaign, with candlelight vigils outside the homes of wavering members of Congress and thank-you events for members of Congress when they returned home after voting for the bill.
Defining a corporate enemy: From the first ads we ran during the 2008 campaign, which had a female cancer survivor who linked Republican candidates to the health insurance industry, through the final ads we ran after the House passed the law, which thanked members of Congress for standing up to the army of 2,000 health insurance lobbyists, we had a clearly defined corporate target. Our tag-line was direct: “If the insurance companies win, we lose.” At the grassroots, we wrapped insurance company offices with yellow crime tape, with the words “It’s a crime to deny our care.” Two weeks before the bill passed, 5,000 activists staged a mass citizens arrest of health insurance company executives when they met at the Ritz-Carlton in Washington.
History matters: For all that we did right, it would not have added up to victory if this hadn’t been the right historical moment. President Obama, Speaker Pelosi, Majority Leader Reid and many other Democrats often talked about history, harking back to Teddy Roosevelt, the New Deal and Harry Truman. President Obama and the Democratic Congress delivered the healthcare baby. The organized progressive forces, led by HCAN, were the midwives to its birth.