A Historian Fights to Protect Healthcare in Trump’s America

by Hannah Greene

Hillary Clinton’s nomination as the presidential candidate of one of our major political parties brought history back into the headlines. Almost a century after women won the right to vote, a woman finally became a serious presidential contender, building the most diverse coalition and the most progressive platform we’ve yet seen in our electoral politics. To many women, Hillary Clinton represented a revolution in her very existence: the revolution of selecting an eminently qualified woman to lead the United States, the revolution of extending social welfare programs in an attainable manner, the revolution of reaching out to unseen and underserved groups like black women and the disability community.

But in its way, Trump’s election was a revolution too, according to the second dictionary definition. His campaign promises were, and his subsequent time in office has proven, nothing if not a dramatic reversal of the Obama administration’s policies and the ones to which millions looked forward as part of the prospective Clinton administration. Focus solely on the issue of healthcare and that fact becomes strikingly clear. Trump’s first act upon entering the Oval Office was to issue an executive order weakening the Affordable Care Act’s individual mandate, taking an axe to one of the cornerstones of the Obama presidency. While consistency is not one of Trump’s strong suits, he has demonstrated a persistence in his efforts to erase President Obama’s legacy.

That moment decisively informed the nature of the political activism I chose to undertake during the Trump administration. Throughout the election, I watched in horror as Trump emboldened the worst forces in our country, from his subtle and overt dog-whistles to white supremacists and neo-Nazis, to his mockery of Serge Kovaleski, to the misogyny and sexism that seemingly fell from him as he breathed. The dark night that he sailed to victory, I knew that I wanted to contribute my time, skills, and resources to protect our civil and Constitutional rights from the demagoguery and heightened racism and bigotry of all stripes that a Trump presidency threatened.

In its way, Trump’s election was a revolution too, according to the second dictionary definition. His campaign promises were, and his subsequent time in office has proven, nothing if not a dramatic reversal.

During the months between election night and Inauguration Day, I debated within myself the form that my activism would take. Nothing—not the racism, not the sexism and misogyny, not the Islamophobia, not the antisemitism, not the xenophobia, not the homophobia, not the transphobia—that we saw from Trump during the campaign or the intervening months was new, although he set it in starker relief than many of us were accustomed to experiencing. This is a country economically grounded in the centuries-long enslavement of black women, men, and children; a country that repeatedly broke its treaties with and pursued ethnic cleansing of Native Americans; a country that turned away Jewish refugees fleeing Nazi Germany; a country that impeded women’s right to obtain a divorce until 1969; a country in which the last state did not overturn the ban against interracial marriage until 2000; and that’s not the half of it. Catering to this element of American impulses should not shock, though it should appall, us. We should, however, be startled by and arouse ourselves to act against the twin propulsions of the Trump administration’s anti-factual ahistorical consciousness that fosters the egregious speech and behavior emanating from his White House, and its desire to turn back the clock on the movement we’ve made towards increased equity and equality.

Any one of these provides abundant cause to get involved politically, and indeed all of them overlap. One cannot fight one form of injustice without touching upon all. But I felt that I would do best focusing on a specific cause, and playing a supportive role in areas where others possessed more expertise. My own history of chronic illness, as well as my historical studies of public health and healthcare policy, influenced my decision to emphasize healthcare equity as my primary issue. Trump’s attack on the ACA’s individual mandate on his very first day in office crystallized my inclinations. Not only did it jeopardize the healthcare upon which millions of Americans rely, it levied a direct assault on the single greatest legislative reform to our healthcare system since the Great Society. The Affordable Care Act is too infrequently acknowledged as the monumental achievement that it is, but as both a historian and a woman who has lived with chronic illness since I was a young child, I fully recognize the sea change that it represents for chronically ill and disabled people across the country. No longer can insurance companies discriminate against people with preexisting conditions, either by charging them unaffordable premiums or denying them coverage altogether. No longer can insurance companies require women to pay more than men for healthcare. No longer can insurance companies subject people with serious medical conditions to the indignity and anxiety of annual and lifetime caps that force them to decide between paying for vital treatment, sending their children to college, or even putting food on the table. It stopped the practice of valuing people according to their health status. The failure to contextualize the ACA in our slow and contested history of health policy reform, compounded with the imminent threat that the Trump administration poses to it, put the law and thus millions of Americans’ healthcare in severe danger.

I knew that I wanted to contribute my time, skills, and resources to protect our civil and Constitutional rights from the demagoguery and heightened racism and bigotry of all stripes that a Trump presidency threatened.

The dire straits in which Trump, his department of Health and Human Services, and the Republican-controlled Congress placed the Affordable Care Act propelled me to found Caring for Us Indivisible. It is an organization devoted to protecting, defending, and educating about the Affordable Care Act, Medicaid, and Medicare, with particular focus on women’s health, reproductive justice, and both chronic and invisible illnesses and disability—not only because these are all intrinsically valuable, but because making it even as far as we have in providing affordable, comprehensive, quality healthcare has been an uphill battle.

Our country’s healthcare history is one of slow and painful forward motion. Since New York State’s effort to pass compulsory health insurance during the Progressive Era, multiple states have sought and failed to pass a mandatory or single payer form of healthcare. Perhaps the most well known federal attempt to pass universal healthcare was in the mid-90s, during the Clinton administration. Although Bill Clinton signed the Children’s Health Insurance Program (CHIP) into law in 1997 (which, stymied by Republican foot-dragging, Congress has still yet to reauthorize), universal healthcare failed under his tenure. Nor did Obama manage to pass universal healthcare as he desired, but he did oversee the sweeping overhaul of our healthcare system and policies embodied in the ACA.

The ACA has indubitably enhanced the quality of life, economic security, and overall health for millions of Americans, expanding healthcare coverage and thus medical treatment to more people than ever prior in our history. Insurers must provide affordable and quality coverage to all Americans, and must cover a thorough set of benefits that encompass the entirety of medicine. Racial and ethnic healthcare discrepancies, while by no means eradicated, are at lower levels than prior to the law’s passage. It addressed the medical model as well, fostering a shift from fee-for-service to value-based care, incentivizing doctors to collaborate and scout out the root of patients’ problems rather than working at cross-purposes and prescribing excessive medications and tests to maximize profits. As significant as all of this is, it represents a mere tip of the iceberg of the profound positive changes that the ACA has already wrought in people’s lives and that it still has the potential to do if administered properly.

Since day one, Trump has demonstrated his intent to decimate the ACA by any means at his disposal. Should he succeed in doing so, that threatens more than the law itself, more than a fifth of our economy and the jobs of people throughout the country, more than millions of people’s critical healthcare and lives—though each of these provides copious reason to act to protect the ACA. So too, it also threatens our progress towards universal healthcare.

Caring for Us Indivisible champions the lives and health of those dealing with serious illnesses and those fortunate to have good health, grounded in the same principle that undergirds the ACA: the fundamental belief that all people are worthy, that all people are important, and that all people deserve healthcare. As those familiar with our country’s healthcare policy will attest, attaining federal recognition of that premise was certainly not a fait accompli and entailed no small feat. And I, as a person living with chronic illnesses and as a historian who studies public health, cannot and will not go back. The stakes are simply too high.

Hannah Greene is doctoral student in American Jewish history, with a focus in women’s and gender studies, at the Skirball Department of Hebrew and Judaic Studies at New York University. Her research concentrates on American Jewish women’s healthcare activism.

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