At a rally to mark its twentieth anniversary, ACT UP was far more polite than it was the year it began, said Eric Sawyer, a founding member of the AIDS activism group. Yet the 500 people who marched through lower Manhattan March 29 expressed a sense of conviction seldom heard these days. Hoping to bolster dwindling membership and decreasing political punch, ACT UP New York has expanded its focus beyond HIV and AIDS to universal healthcare and has recently kicked off a two-year campaign, in collaboration with Physicians for a National Health Program (PNHP) and Health Care Now, to advocate for a single-payer healthcare system and drug-pricing controls.

AIDS activists take pride in their role in securing Ryan White CARE Act, the concern of celebrity commentators, dedicated nonprofit agencies and their issue’s foothold, however insufficient, in national consciousness, but in recent times ACT UP has struggled to retain its sense of outrage and immediacy. The new focus on healthcare for all is indicative of ACT UP’s efforts to become more relevant to the needs of a larger population and to galvanize grassroots activism around fresher issues. Nearly one-third of all Americans’ healthcare costs go to the private insurance’s bureaucracy and paperwork, and a single-payer system, PNHP claims, would free $350 million in healthcare spending, enough to insure those who currently are not adequately covered. ACT UP is joining PNHP to call for the passage the National Health Insurance Act, also known as a “Medicare for All” bill, which would make all Americans eligible for national health insurance and would eliminate co-pays, premiums and deductibles.

The crowd that moved along the sidewalks and in and out of scaffolding at the March 29 rally included ACT UP lifers, new converts, AIDS service professionals and people who live with the virus. Kaytee Riek, 22, arrived on a bus full of fifty other members of ACT UP Philadelphia; she thinks of ACT UP/Philly as her full-time job. Working within the system “is not enough,” Riek says, and will never be. She quit a job doing HIV counseling and testing and now works at a coffee shop, focusing her energy on activism. For service organizations, she claims, “the cards stay the same in the deck, they’re just rearranging them. We want to change the cards in the deck.” She says ACT UP Philly can claim success in prisons, an area notoriously resistant to pressure from advocacy groups. When ACT UP heard that corrections officers were confiscating the condoms that local nonprofits were legally distributing in prisons, ACT UP members met with the local prisons commissioner and got the condom distribution policy enforced. ACT UP is “not about charity, it’s not about helping others, it’s about lifting ourselves up together,” she says.

But even activism is now part of the system. At a recent protest not organized by ACT UP, Bill Dobbs, a longtime ACT UP member, was surprised to be offered a stipend from an HIV services nonprofit for participating in an advocacy event. But Dobbs echoes Riek when he insists that “advocacy has to be done by people not on a payroll”–which is how ACT UP was founded, and how it still operates. Large service organizations are always biased by trying to keep themselves in business, he points out. All-volunteer groups like ACT UP can exert pressure, think more broadly (as exemplified by ACT UP’s new focus) and make demands without regard to funding concerns.

At the Charging Bull in Bowling Green Park, activists piled up fifty imitation body bags, representing the number of Americans who die each day because of a lack of adequate healthcare. Then, amid chants of “No more bull! Healthcare for all!” twenty-seven participants lay down in the street. Within ten minutes, they were arrested, and the crowd slowly dispersed.

Larry Kramer, who founded ACT UP in 1987, said the rally–a “kickoff” event of what organizers claim is the newly reinvigorated ACT UP–“exceeded my expectations.” Kramer, who has long insisted that contemporary LGBT people and people with HIV are not angry or strident enough in their demands, claimed that “we’re too docile, too satiated by creature comforts to be angry.”

But for Eric Sawyer, who noted that Thursday’s turnout matched the attendance at ACT UP’s first public action at Trinity Church twenty years ago, there are reasons to be civil. “There was more anger and urgency back then,” he says, but in Thursday’s march, “we wanted people to be involved for whom getting arrested was not an option.” Getting permits, negotiating with police beforehand and maintaining cordial relations with the police escort “insured the safety of everyone.”

“AIDS has lost its vibrancy,” Kramer told me. But when Clarence Henderson, a member of the New York City AIDS Housing Network, asked street vendors selling hot dogs, scarves and jewelry, “Hey man, you got healthcare?” most said they didn’t and accepted the fliers he was handing out. Well, then, said Henderson, “you should be down with ACT UP.”